WorldWideScience

Sample records for failure advancing policies

  1. Advanced Heart Failure

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Advanced Heart Failure Updated:May 9,2017 When heart failure (HF) ... Making This content was last reviewed May 2017. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  2. Urban Transport Policies: The Dutch Struggle with Market Failures and Policy Failures

    NARCIS (Netherlands)

    Rietveld, Piet

    2004-01-01

    Transport is characterised by market failures that are of particular importance in urban settings. This paper reviews market failures and policy failures in The Netherlands for various transport markets, including road transport, public transport and biking. Special attention is paid to parking

  3. Planning Ahead: Advanced Heart Failure

    Science.gov (United States)

    ... Venous Thromboembolism Aortic Aneurysm More Planning Ahead: Advanced Heart Failure Updated:May 9,2017 An important part of ... Care This content was last reviewed May 2017. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  4. Market failure, policy failure and other distortions in chronic disease markets

    Directory of Open Access Journals (Sweden)

    Segal Leonie

    2009-06-01

    Full Text Available Abstract Background The increasing prevalence of chronic disease represents a significant burden on most health systems. This paper explores the market failures and policy failures that exist in the management of chronic diseases. Discussion There are many sources of market failure in health care that undermine the efficiency of chronic disease management. These include incomplete information as well as information asymmetry between providers and consumers, the effect of externalities on consumer behaviour, and the divergence between social and private time preference rates. This has seen government and policy interventions to address both market failures and distributional issues resulting from the inability of private markets to reach an efficient and equitable distribution of resources. However, these have introduced a series of policy failures such as distorted re-imbursement arrangements across modalities and delivery settings. Summary The paper concludes that market failure resulting from a preference of individuals for 'immediate gratification' in the form of health care and disease management, rather than preventative services, where the benefits are delayed, has a major impact on achieving an efficient allocation of resources in markets for the management of chronic diseases. This distortion is compounded by government health policy that tends to favour medical and pharmaceutical interventions further contributing to distortions in the allocation of resources and inefficiencies in the management of chronic disease.

  5. Failure and damage analysis of advanced materials

    CERN Document Server

    Sadowski, Tomasz

    2015-01-01

    The papers in this volume present basic concepts and new developments in failure and damage analysis with focus on advanced materials such as composites, laminates, sandwiches and foams, and also new metallic materials. Starting from some mathematical foundations (limit surfaces, symmetry considerations, invariants) new experimental results and their analysis are shown. Finally, new concepts for failure prediction and analysis will be introduced and discussed as well as new methods of failure and damage prediction for advanced metallic and non-metallic materials. Based on experimental results the traditional methods will be revised.

  6. Clinical findings and survival time in dogs with advanced heart failure.

    Science.gov (United States)

    Beaumier, Amelie; Rush, John E; Yang, Vicky K; Freeman, Lisa M

    2018-04-10

    Dogs with advanced heart failure are a clinical challenge for veterinarians but there are no studies reporting clinical features and outcome of this population. To describe clinical findings and outcome of dogs with advanced heart failure caused by degenerative mitral valve disease (DMVD). Fifty-four dogs with advanced heart failure because of DMVD. For study purposes, advanced heart failure was defined as recurrence of congestive heart failure signs despite receiving the initially prescribed dose of pimobendan, angiotensin-converting-enzyme inhibitor (ACEI), and furosemide >4 mg/kg/day. Data were collected for the time of diagnosis of Stage C heart failure and time of diagnosis of advanced heart failure. Date of death was recorded. At the diagnosis of advanced heart failure, doses of pimobendan (n = 30), furosemide (n = 28), ACEI (n = 13), and spironolactone (n = 4) were increased, with ≥1 new medications added in most dogs. After initial diagnosis of advanced heart failure, 38 (70%) dogs had additional medications adjustments (median = 2 [range, 0-27]), with the final total medication number ranging from 2-10 (median = 5). Median survival time after diagnosis of advanced heart failure was 281 days (range, 3-885 days). Dogs receiving a furosemide dose >6.70 mg/kg/day had significantly longer median survival times (402 days [range, 3-885 days] versus 129 days [range 9-853 days]; P = .017). Dogs with advanced heart failure can have relatively long survival times. Higher furosemide dose and non-hospitalization were associated with longer survival. Copyright © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  7. Market failures and government policies in gas markets

    International Nuclear Information System (INIS)

    Mulder, M; Zwart, G.

    2006-02-01

    This memorandum analyses the fundamental characteristics of the natural gas market and its consequences for government policies. In the past, the European gas market was dominated by state-owned monopolists but since the start of the liberalisation, privatisation and re-regulation in the early 1990s, the market has fundamentally changed. Nevertheless, governments are still involved in the gas industry, not only in gas exporting countries such as Russia, but also in a country like the Netherlands where the government has imposed a cap on production from the main gas field (Groningen) as well as owns shares in the main wholesale trader (Gasunie Trade and Supply) which has the obligation to accept all gas offered by producers on the small fields. In the main report of this project we present a cost-benefit analysis of the Dutch gas-depletion policy. In this memorandum we explore the natural-gas market more broadly, looking for factors why government intervention may be needed using the welfare-economic approach according to which government intervention should be based on the presence of market failures. After a brief description of the main characteristics of the gas industry, we systematically analyse sources of market failures, such as geopolitical factors, economies of scale and externalities, and finally go into the question which policy options may be chosen to address those market failures

  8. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Vase, Henrik; Gjedsted, Jakob

    2016-01-01

    Heart failure is one of the most common causes of morbidity and mortality worldwide. When patients cease to respond adequately to optimal medical therapy mechanical circulatory support has been promising. The advent of mechanical circulatory support devices has allowed significant improvements...... in patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support....

  9. Public values and public failure in US science policy

    OpenAIRE

    Barry Bozeman; Daniel Sarewitz

    2005-01-01

    Domestic science policy in the United States is linked inextricably to economic thinking. We seek to develop a practical analytical framework that confronts the manifest problems of economic valuing for science and technology activities. We argue that pervasive use of market valuation, market-failure assumptions and economic metaphors shapes the structure of science policy in undesirable ways. In particular, reliance on economic reasoning tends to shift the discourse about science policy away...

  10. Technological advances in extracorporeal membrane oxygenation for respiratory failure.

    Science.gov (United States)

    Rehder, Kyle J; Turner, David A; Bonadonna, Desiree; Walczak, Richard J; Rudder, Robert J; Cheifetz, Ira M

    2012-08-01

    Extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric cardiac and/or respiratory failure is well established, and its use for adult respiratory failure is rapidly increasing. Management strategies developed over the past 30 years coupled with significant recent technological advances have led to improved ECMO survival. These new technologies are expanding the potential applications for ECMO in exciting ways, including new patient populations and the ability to make ECMO mobile for both intra- and inter-hospital transport. In this article, we highlight some of the recent technological advances and their impact on the utilization of ECMO in increasingly diverse patient populations.

  11. Policies toward advanced display in the Clinton administration

    Science.gov (United States)

    Hart, Jeffrey A.

    1994-04-01

    The Clinton administration is using its policy toward advanced displays as a test case for making industry-specific policies. They have established a number of criteria for advanced displays that they hope to apply to other industries in the future. For example, they want to support the development of generic technologies through ARPA and NIST, while minimizing the government's role in key business decisions. They want the industry (by which they mean the tool makers, the component assemblers, and the systems firms) to agree internally before they go ahead with their promotional policies. Given the past history of the advanced display industry, especially its disunity in regard to the enforcement of the successful antidumping petition of the Advanced Display Manufacturers Association and to efforts to create the U.S. Display Consortium, these criteria will be hard to meet. Nevertheless, there now appears to be much greater consensus among the three groups than in the past on the need to build indigenous technological capabilities in advanced displays.

  12. Analytical method for optimization of maintenance policy based on available system failure data

    International Nuclear Information System (INIS)

    Coria, V.H.; Maximov, S.; Rivas-Dávalos, F.; Melchor, C.L.; Guardado, J.L.

    2015-01-01

    An analytical optimization method for preventive maintenance (PM) policy with minimal repair at failure, periodic maintenance, and replacement is proposed for systems with historical failure time data influenced by a current PM policy. The method includes a new imperfect PM model based on Weibull distribution and incorporates the current maintenance interval T 0 and the optimal maintenance interval T to be found. The Weibull parameters are analytically estimated using maximum likelihood estimation. Based on this model, the optimal number of PM and the optimal maintenance interval for minimizing the expected cost over an infinite time horizon are also analytically determined. A number of examples are presented involving different failure time data and current maintenance intervals to analyze how the proposed analytical optimization method for periodic PM policy performances in response to changes in the distribution of the failure data and the current maintenance interval. - Highlights: • An analytical optimization method for preventive maintenance (PM) policy is proposed. • A new imperfect PM model is developed. • The Weibull parameters are analytically estimated using maximum likelihood. • The optimal maintenance interval and number of PM are also analytically determined. • The model is validated by several numerical examples

  13. Antimicrobial resistance and biological governance: explanations for policy failure.

    Science.gov (United States)

    Wallinga, D; Rayner, G; Lang, T

    2015-10-01

    The paper reviews the state of policy on antimicrobial use and the growth of antimicrobial resistance (AMR). AMR was anticipated at the time of the first use of antibiotics by their originators. For decades, reports and scientific papers have expressed concern about AMR at global and national policy levels, yet the problem, first exposed a half-century ago, worsened. The paper considers the explanations for this policy failure and the state of arguments about ways forward. These include: a deficit of economic incentivisation; complex interventions in behavioural dynamics; joint and separate shifts in medical and animal health regimes; consumerism; belief in technology; and a narrative that in a 'war on bugs' nature can be beaten by human ingenuity. The paper suggests that these narratives underplay the biological realities of the human-animal-biosphere being in constant flux, an understanding which requires an ecological public health analysis of AMR policy development and failure. The paper suggests that effective policy change requires simultaneous actions across policy levels. No single solution is possible, since AMR is the result of long-term human intervention which has accelerated certain trends in the evolution of a microbial ecosystem shared by humans, animals and other biological organisms inhabiting that ecosystem. Viewing the AMR crisis today through an ecological public health lens has the advantage of reuniting the social-ecological and bio-ecological perspectives which have been separated within public health. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  14. Evaluating Forecasts, Narratives and Policy Using a Test of Invariance

    Directory of Open Access Journals (Sweden)

    Jennifer L. Castle

    2017-09-01

    Full Text Available Economic policy agencies produce forecasts with accompanying narratives, and base policy changes on the resulting anticipated developments in the target variables. Systematic forecast failure, defined as large, persistent deviations of the outturns from the numerical forecasts, can make the associated narrative false, which would in turn question the validity of the entailed policy implementation. We establish when systematic forecast failure entails failure of the accompanying narrative, which we call forediction failure, and when that in turn implies policy invalidity. Most policy regime changes involve location shifts, which can induce forediction failure unless the policy variable is super exogenous in the policy model. We propose a step-indicator saturation test to check in advance for invariance to policy changes. Systematic forecast failure, or a lack of invariance, previously justified by narratives reveals such stories to be economic fiction.

  15. The patient perspective: Quality of life in advanced heart failure with frequent hospitalisations.

    Science.gov (United States)

    Nieminen, Markku S; Dickstein, Kenneth; Fonseca, Cândida; Serrano, Jose Magaña; Parissis, John; Fedele, Francesco; Wikström, Gerhard; Agostoni, Piergiuseppe; Atar, Shaul; Baholli, Loant; Brito, Dulce; Colet, Josep Comín; Édes, István; Gómez Mesa, Juan E; Gorjup, Vojka; Garza, Eduardo Herrera; González Juanatey, José R; Karanovic, Nenad; Karavidas, Apostolos; Katsytadze, Igor; Kivikko, Matti; Matskeplishvili, Simon; Merkely, Béla; Morandi, Fabrizio; Novoa, Angel; Oliva, Fabrizio; Ostadal, Petr; Pereira-Barretto, Antonio; Pollesello, Piero; Rudiger, Alain; Schwinger, Robert H G; Wieser, Manfred; Yavelov, Igor; Zymliński, Robert

    2015-07-15

    End of life is an unfortunate but inevitable phase of the heart failure patients' journey. It is often preceded by a stage in the progression of heart failure defined as advanced heart failure, and characterised by poor quality of life and frequent hospitalisations. In clinical practice, the efficacy of treatments for advanced heart failure is often assessed by parameters such as clinical status, haemodynamics, neurohormonal status, and echo/MRI indices. From the patients' perspective, however, quality-of-life-related parameters, such as functional capacity, exercise performance, psychological status, and frequency of re-hospitalisations, are more significant. The effects of therapies and interventions on these parameters are, however, underrepresented in clinical trials targeted to assess advanced heart failure treatment efficacy, and data are overall scarce. This is possibly due to a non-universal definition of the quality-of-life-related endpoints, and to the difficult standardisation of the data collection. These uncertainties also lead to difficulties in handling trade-off decisions between quality of life and survival by patients, families and healthcare providers. A panel of 34 experts in the field of cardiology and intensive cardiac care from 21 countries around the world convened for reviewing the existing data on quality-of-life in patients with advanced heart failure, discussing and reaching a consensus on the validity and significance of quality-of-life assessment methods. Gaps in routine care and research, which should be addressed, were identified. Finally, published data on the effects of current i.v. vasoactive therapies such as inotropes, inodilators, and vasodilators on quality-of-life in advanced heart failure patients were analysed. Copyright © 2015. Published by Elsevier Ireland Ltd.

  16. Work/Life Satisfaction Policy in ADVANCE Universities: Assessing Levels of Flexibility

    Science.gov (United States)

    Tower, Leslie E.; Dilks, Lisa M.

    2015-01-01

    Work/life satisfaction policies are seen as key to recruiting, retaining, and advancing high quality faculty. This article explores the work/life policies prevalent at NSF ADVANCE institutions (PAID, Catalyst, and IT). We systematically review ADVANCE university websites (N = 124) and rank 9 categories of work/life policy including dual career…

  17. Predictive Simulation of Material Failure Using Peridynamics -- Advanced Constitutive Modeling, Verification and Validation

    Science.gov (United States)

    2016-03-31

    AFRL-AFOSR-VA-TR-2016-0309 Predictive simulation of material failure using peridynamics- advanced constitutive modeling, verification , and validation... Self -explanatory. 8. PERFORMING ORGANIZATION REPORT NUMBER. Enter all unique alphanumeric report numbers assigned by the performing organization, e.g...for public release. Predictive simulation of material failure using peridynamics-advanced constitutive modeling, verification , and validation John T

  18. Advance care planning for nursing home residents with dementia: policy vs. practice.

    Science.gov (United States)

    Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

    2016-03-01

    The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

  19. Advanced chronic kidney disease in non-valvular atrial fibrillation: extending the utility of R2CHADS2 to patients with advanced renal failure.

    Science.gov (United States)

    Bautista, Josef; Bella, Archie; Chaudhari, Ashok; Pekler, Gerald; Sapra, Katherine J; Carbajal, Roger; Baumstein, Donald

    2015-04-01

    The R2CHADS2 is a new prediction rule for stroke risk in atrial fibrillation (AF) patients wherein R stands for renal risk. However, it was created from a cohort that excluded patients with advanced renal failure (defined as glomerular filtration rate of advanced renal failure and aims to compare its predictive power against the currently used CHADS and CHA2DS2VaSc. This retrospective cohort study analyzed the 1-year risk for stroke of the 524 patients with AF at Metropolitan Hospital Center. AUC and C statistics were calculated using three groups: (i) the entire cohort including patients with advanced renal failure, (ii) a cohort excluding patients with advanced renal failure and (iii) all patients with GFR statistic was highest in R2CHADS compared with CHADS or CHADSVASC in group 1 (0.718 versus 0.605 versus 0.602) and in group 2 (0.724 versus 0.584 versus 0.579). However, there was no statistically significant difference in group 3 (0.631 versus 0.629 versus 0.623). Our study supports the utility of R2CHADS2 as a clinical prediction rule for stroke risk in patients with advanced renal failure.

  20. Role of long-term mechanical circulatory support in patients with advanced heart failure.

    Science.gov (United States)

    Stokes, M B; Bergin, P; McGiffin, D

    2016-05-01

    Advanced heart failure represents a small proportion of patients with heart failure that possess high-risk features associated with high hospital readmission rates, significant functional impairment and mortality. Identification of those who have progressed to, or are near a state of advanced heart failure should prompt referral to a service that offers therapies in mechanical circulatory support (MCS) and cardiac transplantation. MCS has grown as a management strategy in the care of these patients, most commonly as a bridge to cardiac transplantation. The predominant utilisation of MCS is implantation of left ventricular assist devices (LVAD), which have evolved significantly in their technology and application over the past 15-20 years. The technology has evolved to such an extent that Destination Therapy is now being utilised as a strategy in management of advanced heart failure in appropriately selected patients. Complication rates have decreased with VAD implantation, but remain a significant consideration in the decision to implant a device, and in the follow up of these patients. © 2016 Royal Australasian College of Physicians.

  1. Left ventricular assist device therapy in advanced heart failure

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Rogers, Joseph G

    2017-01-01

    Despite improvements in pharmacological therapy and pacing, prognosis in advanced heart failure (HF) remains poor, with a 1-year mortality of 25-50%. While heart transplantation provides excellent survival and quality of life for eligible patients, only a few can be offered this treatment due...

  2. Advanced approaches to failure mode and effect analysis (FMEA applications

    Directory of Open Access Journals (Sweden)

    D. Vykydal

    2015-10-01

    Full Text Available The present paper explores advanced approaches to the FMEA method (Failure Mode and Effect Analysis which take into account the costs associated with occurrence of failures during the manufacture of a product. Different approaches are demonstrated using an example FMEA application to production of drawn wire. Their purpose is to determine risk levels, while taking account of the above-mentioned costs. Finally, the resulting priority levels are compared for developing actions mitigating the risks.

  3. Market failures and barriers as a basis for clean energy policies

    International Nuclear Information System (INIS)

    Brown, M.A.

    2001-01-01

    This paper provides compelling evidence that large-scale market failures and barriers prevent consumers in the United States from obtaining energy services at least cost. Assessments of numerous energy policies and programs suggest that public interventions can overcome many of these market obstacles. By articulating these barriers and reviewing the literature on ways of addressing them, this paper provides a strong justification for the policy portfolios that define the ''Scenarios for a Clean Energy Future'', a study conducted by five National Laboratories. These scenarios are described in other papers published in this special issue of Energy Policy. (author)

  4. Predicting device failure after percutaneous repair of functional mitral regurgitation in advanced heart failure: Implications for patient selection.

    Science.gov (United States)

    Stolfo, Davide; De Luca, Antonio; Morea, Gaetano; Merlo, Marco; Vitrella, Giancarlo; Caiffa, Thomas; Barbati, Giulia; Rakar, Serena; Korcova, Renata; Perkan, Andrea; Pinamonti, Bruno; Pappalardo, Aniello; Berardini, Alessandra; Biagini, Elena; Saia, Francesco; Grigioni, Francesco; Rapezzi, Claudio; Sinagra, Gianfranco

    2018-04-15

    Patients with heart failure (HF) and severe symptomatic functional mitral regurgitation (FMR) may benefit from MitraClip implantation. With increasing numbers of patients being treated the success of procedure becomes a key issue. We sought to investigate the pre-procedural predictors of device failure in patients with advanced HF treated with MitraClip. From April 2012 to November 2016, 76 patients with poor functional class (NYHA class III-IV) and severe left ventricular (LV) remodeling underwent MitraClip implantation at University Hospitals of Trieste and Bologna (Italy). Device failure was assessed according to MVARC criteria. Patients were subsequently followed to additionally assess the patient success after 12months. Mean age was 67±12years, the mean Log-EuroSCORE was 23.4±16.5%, and the mean LV end-diastolic volume index and ejection fraction (EF) were 112±33ml/m 2 and 30.6±8.9%, respectively. At short-term evaluation, device failure was observed in 22 (29%) patients. Univariate predictors of device failure were LVEF, LV and left atrial volumes and anteroposterior mitral annulus diameter. Annulus dimension (OR 1.153, 95% CI 1.002-1.327, p=0.043) and LV end-diastolic volume (OR 1.024, 95% CI 1.000-1.049, p=0.049) were the only variables independently associated with the risk of device failure at the multivariate model. Pre-procedural anteroposterior mitral annulus diameter accurately predicted the risk of device failure after MitraClip in the setting of advanced HF. Its assessment might aid the selection of the best candidates to percutaneous correction of FMR. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Development of a conceptual policy framework for advanced practice nursing: an ethnographic study.

    Science.gov (United States)

    Schober, Madrean M; Gerrish, Kate; McDonnell, Ann

    2016-06-01

    To report on a study examining policy development for advanced practice nursing from intent of policy to realization in practice. Inclusion of advanced practice nursing roles in the healthcare workforce is a worldwide trend. Optimal advanced nursing practice requires supportive policies. Little is known about how policy is developed and implemented. Ethnography using an instrumental case study approach was selected to give an in-depth understanding of the experiences of one country (Singapore) to contribute to insight into development elsewhere. The four-phase study was conducted from 2008-2012 and included document analysis (n = 47), interviews with key policy decision makers (n = 12), interviews with nursing managers and medical directors (n = 11), interviews and participant observation with advanced practice nurses (n = 15). Key policymakers in positions of authority were able to promote policy development. However, this was characterized by lack of strategic planning for implementation. A vague understanding by nursing managers and medical directors of policies, the role and its position in the healthcare workforce led to indecision and uncertainty in execution. Advanced practice nurses developed their role based on theory acquired in their academic programme but were unsure what role to assume in practice. Lack of clear guidelines led to unanticipated difficulties for institutions and healthcare systems. Strategic planning could facilitate integration of advanced practice nurses into the healthcare workforce. A Conceptual Policy Framework is proposed as a guide for a coordinated approach to policy development and implementation for advanced practice nursing. © 2016 John Wiley & Sons Ltd.

  6. Utility of the Seattle Heart Failure Model in patients with advanced heart failure.

    Science.gov (United States)

    Kalogeropoulos, Andreas P; Georgiopoulou, Vasiliki V; Giamouzis, Grigorios; Smith, Andrew L; Agha, Syed A; Waheed, Sana; Laskar, Sonjoy; Puskas, John; Dunbar, Sandra; Vega, David; Levy, Wayne C; Butler, Javed

    2009-01-27

    The aim of this study was to validate the Seattle Heart Failure Model (SHFM) in patients with advanced heart failure (HF). The SHFM was developed primarily from clinical trial databases and extrapolated the benefit of interventions from published data. We evaluated the discrimination and calibration of SHFM in 445 advanced HF patients (age 52 +/- 12 years, 68.5% male, 52.4% white, ejection fraction 18 +/- 8%) referred for cardiac transplantation. The primary end point was death (n = 92), urgent transplantation (n = 14), or left ventricular assist device (LVAD) implantation (n = 3); a secondary analysis was performed on mortality alone. Patients were receiving optimal therapy (angiotensin-II modulation 92.8%, beta-blockers 91.5%, aldosterone antagonists 46.3%), and 71.0% had an implantable device (defibrillator 30.4%, biventricular pacemaker 3.4%, combined 37.3%). During a median follow-up of 21 months, 109 patients (24.5%) had an event. Although discrimination was adequate (c-statistic >0.7), the SHFM overall underestimated absolute risk (observed vs. predicted event rate: 11.0% vs. 9.2%, 21.0% vs. 16.6%, and 27.9% vs. 22.8% at 1, 2, and 3 years, respectively). Risk underprediction was more prominent in patients with an implantable device. The SHFM had different calibration properties in white versus black patients, leading to net underestimation of absolute risk in blacks. Race-specific recalibration improved the accuracy of predictions. When analysis was restricted to mortality, the SHFM exhibited better performance. In patients with advanced HF, the SHFM offers adequate discrimination, but absolute risk is underestimated, especially in blacks and in patients with devices. This is more prominent when including transplantation and LVAD implantation as an end point.

  7. Echocardiographic evaluation of right ventricular stroke work index in advanced heart failure: a new index?

    Science.gov (United States)

    Frea, Simone; Bovolo, Virginia; Bergerone, Serena; D'Ascenzo, Fabrizio; Antolini, Marina; Capriolo, Michele; Canavosio, Federico Giovanni; Morello, Mara; Gaita, Fiorenzo

    2012-12-01

    Right ventricular (RV) function plays a pivotal role in advanced heart failure patients, especially for screening those who may benefit from left ventricular assist device (LVAD) implantation. We introduce RV contraction pressure index (RVCPI) as a new echo-Doppler parameter of RV function. The accuracy of RVCPI in detecting RV failure was compared with the criterion standard, the RV stroke work index (RVSWI) obtained through right heart catheterization in advanced heart failure patients referred for heart transplantation or LVAD implantation. Right heart catheterization and echo-Doppler were simultaneously performed in 94 consecutive patients referred to our center for advanced heart failure (ejection fraction (EF) 24 ± 8.8%, 40% NYHA functional class IV). RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. Simplified RVCPI (sRVCPI) was derived as TAPSE × (RV - right atrial pressure gradient). Close positive correlation between sRVCPI and RVSWI was found (r = 0.68; P rights reserved.

  8. Research, development, demonstration, and early deployment policies for advanced-coal technology in China

    International Nuclear Information System (INIS)

    Zhao Lifeng; Gallagher, Kelly Sims

    2007-01-01

    Advanced-coal technologies will increasingly play a significant role in addressing China's multiple energy challenges. This paper introduces the current status of energy in China, evaluates the research, development, and demonstration policies for advanced-coal technologies during the Tenth Five-Year Plan, and gives policy prospects for advanced-coal technologies in the Eleventh Five-Year Plan. Early deployment policies for advanced-coal technologies are discussed and some recommendations are put forward. China has made great progress in the development of advanced-coal technologies. In terms of research, development, and demonstration of advanced-coal technologies, China has achieved breakthroughs in developing and demonstrating advanced-coal gasification, direct and indirect coal liquefaction, and key technologies of Integrated Gasification Combined Cycle (IGCC) and co-production systems. Progress on actual deployment of advanced-coal technologies has been more limited, in part due to insufficient supporting policies. Recently, industry chose Ultra Super Critical (USC) Pulverized Coal (PC) and Super Critical (SC) PC for new capacity coupled with pollution-control technology, and 300 MW Circulating Fluidized Bed (CFB) as a supplement

  9. Management of Heart Failure in Advancing CKD: Core Curriculum 2018.

    Science.gov (United States)

    House, Andrew A

    2018-02-23

    Heart failure and chronic kidney disease have increasing incidence and prevalence owing in part to the aging population and increasing rates of hypertension, diabetes, and other cardiovascular and kidney disease risk factors. The presence of one condition also has a strong influence on the other, leading to greater risks for hospitalization, morbidity, and death, as well as very high health care costs. Despite the frequent coexistence of heart failure and chronic kidney disease, many of the pivotal randomized trials that guide the management of heart failure have excluded patients with more advanced stages of chronic kidney disease. In this Core Curriculum article, management of a challenging, yet not unusual, case of heart failure with reduced ejection fraction in a patient with stage 4 chronic kidney disease provides an opportunity to review the relevant literature and highlight gaps in our knowledge. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  10. Patterns of failure after involved field radiotherapy for locally advanced esophageal squamous cell carcinoma.

    Science.gov (United States)

    Li, Duo-Jie; Li, Hong-Wei; He, Bin; Wang, Geng-Ming; Cai, Han-Fei; Duan, Shi-Miao; Liu, Jing-Jing; Zhang, Ya-Jun; Cui, Zhen; Jiang, Hao

    2016-01-01

    To retrospectively analyze the patterns of failure and the treatment effects of involved-field irradiation (IFI) on patients treated with locally advanced esophageal squamous cell carcinoma (ESCC) and to determine whether IFI is practicable in these patients. A total of 79 patients with locally advanced ESCC underwent three dimensional conformal (3D)CRT) or intensity modulated radiotherapy (IMRT) using IFI or elective nodal irradiation (ENI) according to the target volume. The patterns of failure were defined as local/regional, in-field, out)of)field regional lymph node (LN) and distant failure. With a median follow)up of 32.0 months, failures were observed in 66 (83.6%) patients. The cumulative incidence of local/regional failure (55.8 vs 52.8%) and in)field regional lymph node failure (25.6 vs 19.4%) showed no statistically significant difference between the IFI and the ENI group (p=0.526 and 0.215, respectively). Out)of)field nodal relapse rate of only 7.0% was seen in the IFI group. Three)year survival rates for the ENI and IFI group were 22.2 and 18.6%, respectively (p=0.240), and 3)year distant metastasis rates were 27.8 and 32.6%, respectively (p=0.180). The lung V10, V20, V30 and mean lung dose of the ENI group were greater than those of the IFI group, while the mean lung dose and V10 had statistically significant difference. The patterns of failure and survival rates in the IFI group were similar as in the ENI group; the regional recurrence and distant metastasis are the main cause of treatment failure. IFI is feasible for locally advanced ESCC. Further investigation is needed to increase local control and decrease distant metastasis in these patients.

  11. Living with an unfixable heart: a qualitative study exploring the experience of living with advanced heart failure.

    LENUS (Irish Health Repository)

    Ryan, Marie

    2012-02-01

    BACKGROUND: Nurses working with patients with advanced heart failure need knowledge that will help us to help patients cope with their situations of chronic illness. However, our knowledge bank is deficient due to the scarcity of inquiry that takes the affected person\\'s point of view as its central focus. AIM: The aim of this study was to describe patients\\' experiences of living with advanced heart failure. METHODS: The study sample (N=9) consisted of male (N=6) and female (N=3) patients with advanced (NYHA classes III-IV) heart failure. The design was qualitative and open unstructured interviews were audio-taped and transcribed verbatim during 2006. RESULTS: Four main themes emerged: Living in the Shadow of Fear; Running on Empty; Living a Restricted life; and Battling the System. The experience of living with advanced heart failure was described as a fearful and tired sort of living characterised by escalating impotence and dependence. CONCLUSIONS: The findings suggest that there may be an illogical but enduring ethos of \\'cure\\' pervading health care worker\\'s attitudes to advanced heart failure care. This mindset might be working to hinder the application of additional or alternative therapies, which might better palliate the physical and psychosocial distress of patients.

  12. Linking advanced biofuels policies with stakeholder interests: A method building on Quality Function Deployment

    International Nuclear Information System (INIS)

    Schillo, R. Sandra; Isabelle, Diane A.; Shakiba, Abtin

    2017-01-01

    The field of renewable energy policy is inherently complex due to the long-term impacts of its policies, the broad range of potential stakeholders, the intricacy of scientific, engineering and technological developments, and the interplay of complex policy mixes that may result in unintended consequences. Quality Function Deployment (QFD) provides a systematic consideration of all relevant stakeholders, a rigorous analysis of the needs of stakeholders, and a prioritization of design features based on stakeholders needs. We build on QFD combined with Analytical Hierarchy Process (AHP) to develop a novel method applied to the area of advanced biofuel policies. This Multi-Stakeholder Policy QFD (MSP QFD) provides a systematic approach to capture the voice of the stakeholders and align it with the broad range of potential advanced biofuels policies. To account for the policy environment, the MSP QFD utilizes a novel approach to stakeholder importance weights. This MSP QFD adds to the literature as it permits the analysis of the broad range of relevant national policies with regards to the development of advanced biofuels, as compared to more narrowly focused typical QFD applications. It also allows policy developers to gain additional insights into the perceived impacts of policies, as well as international comparisons. - Highlights: • Advanced biofuels are mostly still in research and early commercialization stages. • Government policies are expected to support biofuels stakeholders in market entry. • A Multi-Stakeholder Policy QFD (MSP QFD) links biofuels policies with stakeholders. • MSP QFD employs novel stakeholder weights method. • The case of advanced biofuels in Canada shows comparative importance of policies.

  13. Advanced composites: Design and application. Proceedings of the meeting of the Mechanical Failures Prevention Group

    Science.gov (United States)

    Shives, T. R.; Willard, W. A.

    1979-01-01

    The design and application of advanced composites is discussed with emphasis on aerospace, aircraft, automotive, marine, and industrial applications. Failure modes in advanced composites are also discussed.

  14. Inotropes do not increase mortality in advanced heart failure

    Directory of Open Access Journals (Sweden)

    Guglin M

    2014-05-01

    Full Text Available Maya Guglin, Marc KaufmanUniversity of South Florida, Tampa, FL, USAAbstract: Inotrope use is one of the most controversial topics in the management of heart failure. While the heart failure community utilizes them and recognizes the state of inotrope dependency, retrospective analyses and registry data have overwhelmingly suggested high mortality, which is logically to be expected given the advanced disease states of those requiring their use. Currently, there is a relative paucity of randomized control trials due to the ethical dilemma of creating control groups by withholding inotropes from patients who require them. Nonetheless, results of such trials have been mixed. Many were also performed with agents no longer in use, on patients without an indication for inotropes, or at a time before automatic cardio-defibrillators were recommended for primary prevention. Thus, their results may not be generalizable to current clinical practice. In this review, we discuss current indications for inotrope use, specifically dobutamine and milrinone, depicting their mechanisms of action, delineating their patterns of use in clinical practice, defining the state of inotrope dependency, and ultimately examining the literature to ascertain whether evidence is sufficient to support the current view that these agents increase mortality in patients with heart failure. Our conclusion is that the evidence is insufficient to link inotropes and increased mortality in low output heart failure.Keywords: inotropes, dobutamine, milrinone, heart failure

  15. System Merits or Failures? Policies for Transition to Sustainable P and N Systems in The Netherlands and Finland

    Directory of Open Access Journals (Sweden)

    Thomas Hoppe

    2016-05-01

    Full Text Available Nitrogen (N and phosphorus (P cycles are absolutely vital in maintaining sustainable food systems. Human activities disturb the natural balance of these cycles by creating enormous additional nutrient fluxes, causing eutrophication of waterways and pollution in land systems. To tackle this problem, sustainable nutrient management is required. This paper addresses sustainable nutrient management in two countries: The Netherlands and Finland. We adopt a critical perspective on resource politics, especially towards opportunistic policy strategies for the pollutant management of N and P. Two research questions are considered. First, what are the key systemic and policy failures that occurred in the N and P systems in the Netherlands and Finland between 1970 and 2015? And second, which lessons can be drawn when addressing the policy responses in the two countries to cope with these failures? The cases are analyzed within Weber and Rohracher’s framework that addresses “failures” preventing sustainable transitions. The results show that a number of failures occurred, besides market failures (over-exploitation of the commons, externalization of costs: lack of directionality, policy coordination, institutions, capabilities, infrastructure, demand articulation, and reflexivity. Policy responses in both countries resulted in ponderous policy frameworks that were adequate to tackle nutrient problems from the industrial sector and municipalities. However, both countries provided only a moderate response in terms of system-wide integrated policy frameworks to cope with sectoral-transcending issues. The agricultural use of N and P, in contrast to detergents, has not been subjected to strong regulatory measures.

  16. Advanced health biotechnologies in Thailand: redefining policy directions.

    Science.gov (United States)

    Velasco, Román Pérez; Chaikledkaew, Usa; Myint, Chaw Yin; Khampang, Roongnapa; Tantivess, Sripen; Teerawattananon, Yot

    2013-01-02

    Thailand faces a significant burden in terms of treating and managing degenerative and chronic diseases. Moreover, incidences of rare diseases are rising. Many of these-such as diabetes, cancer, and inherited inborn metabolic diseases-have no definite treatments or cure. Meanwhile, advanced health biotechnology has been found, in principle, to be an effective solution for these health problems. Qualitative approaches were employed to analyse the current situation and examine existing public policies related to advanced health biotechnologies in Thailand. The results of this analysis were then used to formulate policy recommendations. Our research revealed that the system in Thailand in relation to advanced health biotechnologies is fragmented, with multiple unaddressed gaps, underfunding of research and development (R&D), and a lack of incentives for the private sector. In addition, there are no clear definitions of advanced health biotechnologies, and coverage pathways are absent. Meanwhile, false advertising and misinformation are prevalent, with no responsible bodies to actively and effectively provide appropriate information and education (I&E). The establishment of a specialised institution to fill the gaps in this area is warranted. The development and implementation of a comprehensive national strategic plan related to advanced health biotechnologies, greater investment in R&D and I&E for all stakeholders, collaboration among agencies, harmonisation of reimbursement across public health schemes, and provision of targeted I&E are specifically recommended.

  17. Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement.

    Science.gov (United States)

    de Ruiter, M H T; Apperloo, R C; Milstein, D M J; de Lange, J

    2017-11-01

    Maxillomandibular advancement (MMA) is an alternative therapeutic option that is highly effective for treating obstructive sleep apnoea (OSA). MMA provides a solution for OSA patients that have difficulty accepting lifelong treatments with continuous positive airway pressure or mandibular advancement devices. The goal of this study was to investigate the different characteristics that determine OSA treatment success/failure after MMA. The apnoea-hypopnoea index (AHI) was used to determine the success or failure of OSA treatment after MMA. Sixty-two patients underwent MMA for moderate and severe OSA. A 71% success rate was observed with a mean AHI reduction of 69%. A statistically significant larger neck circumference was measured in patients with failed OSA treatments following MMA (P=0.008), and older patients had failed OSA treatments with MMA: 58 vs. 53 years respectively (P=0.037). Cephalometric analysis revealed no differences between successful and failed OSA treatment outcomes. There was no difference in maxillary and mandibular advancements between success and failed MMA-treated OSA patients. The complications most frequently reported following MMA were sensory disturbances in the inferior alveolar nerve (60%) and malocclusion (24%). The results suggest that age and neck girth may be important factors that could predict susceptibility to OSA treatment failures by MMA. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Development and utilization of the NRC policy statement on the regulation of advanced nuclear power plants

    International Nuclear Information System (INIS)

    Williams, P.M.; King, T.L.

    1988-06-01

    On March 26, 1985, the US Nuclear Regulatory Commission issued for public comment a ''Proposed Policy for Regulation of Advanced Nuclear Power Plants'' (50 FR 11884). This report presents and discusses the Commission's final version of that policy as titled and published on July 8, 1986 ''Regulation of Advanced Nuclear Power Plants, Statement of Policy'' (51 FR 24643). It provides an overview of comments received from the public, of the significant changes from the proposed Policy Statement to the final Policy Statement, and of the Commission's response to six questions contained in the proposed Policy Statement. The report also discusses the definition for advanced reactors, the establishment of an Advanced Reactors Group, the staff review approach and information needs, and the utilization of the Policy Statement in relation to other NRC programs, including the policies for safety goals, severe accidents and standardization. In addition, guidance for advanced reactors with respect to operating experience, technology development, foreign information and data, and prototype testing is provided. Finally, a discussion on the use of less prescriptive and nonprescriptive design criteria for advanced reactors, which the Policy Statement encourages, is presented

  19. Advanced health biotechnologies in Thailand: redefining policy directions

    Directory of Open Access Journals (Sweden)

    Velasco Román Pérez

    2013-01-01

    Full Text Available Abstract Background Thailand faces a significant burden in terms of treating and managing degenerative and chronic diseases. Moreover, incidences of rare diseases are rising. Many of these—such as diabetes, cancer, and inherited inborn metabolic diseases—have no definite treatments or cure. Meanwhile, advanced health biotechnology has been found, in principle, to be an effective solution for these health problems. Methods Qualitative approaches were employed to analyse the current situation and examine existing public policies related to advanced health biotechnologies in Thailand. The results of this analysis were then used to formulate policy recommendations. Results Our research revealed that the system in Thailand in relation to advanced health biotechnologies is fragmented, with multiple unaddressed gaps, underfunding of research and development (R&D, and a lack of incentives for the private sector. In addition, there are no clear definitions of advanced health biotechnologies, and coverage pathways are absent. Meanwhile, false advertising and misinformation are prevalent, with no responsible bodies to actively and effectively provide appropriate information and education (I&E. The establishment of a specialised institution to fill the gaps in this area is warranted. Conclusion The development and implementation of a comprehensive national strategic plan related to advanced health biotechnologies, greater investment in R&D and I&E for all stakeholders, collaboration among agencies, harmonisation of reimbursement across public health schemes, and provision of targeted I&E are specifically recommended.

  20. A Korean perspective on developing a global policy for advance directives.

    Science.gov (United States)

    Kim, Soyoon; Hahm, Ki-Hyun; Park, Hyoung Wook; Kang, Hyun Hee; Sohn, Myongsei

    2010-03-01

    Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible.

  1. High satisfaction and low decisional conflict with advance care planning among chronically ill patients with advanced chronic obstructive pulmonary disease or heart failure using an online decision aid: A pilot study.

    Science.gov (United States)

    Van Scoy, Lauren J; Green, Michael J; Dimmock, Anne Ef; Bascom, Rebecca; Boehmer, John P; Hensel, Jessica K; Hozella, Joshua B; Lehman, Erik B; Schubart, Jane R; Farace, Elana; Stewart, Renee R; Levi, Benjamin H

    2016-09-01

    Many patients with chronic illnesses report a desire for increased involvement in medical decision-making. This pilot study aimed to explore how patients with exacerbation-prone disease trajectories such as advanced heart failure or chronic obstructive pulmonary disease experience advance care planning using an online decision aid and to compare whether patients with different types of exacerbation-prone illnesses had varied experiences using the tool. Pre-intervention questionnaires measured advance care planning knowledge. Post-intervention questionnaires measured: (1) advance care planning knowledge; (2) satisfaction with tool; (3) decisional conflict; and (4) accuracy of the resultant advance directive. Comparisons were made between patients with heart failure and chronic obstructive pulmonary disease. Over 90% of the patients with heart failure (n = 24) or chronic obstructive pulmonary disease (n = 25) reported being "satisfied" or "highly satisfied" with the tool across all satisfaction domains; over 90% of participants rated the resultant advance directive as "very accurate." Participants reported low decisional conflict. Advance care planning knowledge scores rose by 18% (p < 0.001) post-intervention. There were no significant differences between participants with heart failure and chronic obstructive pulmonary disease. Patients with advanced heart failure and chronic obstructive pulmonary disease were highly satisfied after using an online advance care planning decision aid and had increased knowledge of advance care planning. This tool can be a useful resource for time-constrained clinicians whose patients wish to engage in advance care planning. © The Author(s) 2016.

  2. Prognostic incremental role of right ventricular function in acute decompensation of advanced chronic heart failure.

    Science.gov (United States)

    Frea, Simone; Pidello, Stefano; Bovolo, Virginia; Iacovino, Cristina; Franco, Erica; Pinneri, Francesco; Galluzzo, Alessandro; Volpe, Alessandra; Visconti, Massimiliano; Peirone, Andrea; Morello, Mara; Bergerone, Serena; Gaita, Fiorenzo

    2016-05-01

    The purpose of this study was to evaluate the additional prognostic value of echocardiography in acute decompensation of advanced chronic heart failure (CHF), focusing on right ventricular (RV) dysfunction and its interaction with loading conditions. Few data are available on the prognostic role of echocardiography in acute HF and on the significance of pulmonary hypertension in patients with severe RV failure. A total of 265 NYHA IV patients admitted for acute decompensation of advanced CHF (EF 22 ± 7%, systolic blood pressure 107 ± 20 mmHg) were prospectively enrolled. Fifty-nine patients met the primary composite endpoint of cardiac death, urgent heart transplantation, and urgent mechanical circulatory support implantation at 90 days. Pulmonary hypertension failed to predict events, while patients with a low transtricuspid systolic gradient (TR gradient statistic from 0.59 to 0.73 (P advanced CHF, pulmonary hypertension failed to predict events. The in-hospital and short-term prognosis can be better predicted by eRAP and RVCPI. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

  3. A multi-level maintenance policy for a multi-component and multifailure mode system with two independent failure modes

    International Nuclear Information System (INIS)

    Zhu, Wenjin; Fouladirad, Mitra; Bérenguer, Christophe

    2016-01-01

    This paper studies the maintenance modelling of a multi-component system with two independent failure modes with imperfect prediction signal in the context of a system of systems. Each individual system consists of multiple series components and the failure modes of all the components are divided into two classes due to their consequences: hard failure and soft failure, where the former causes system failure while the later results in inferior performance (production reduction) of system. Besides, the system is monitored and can be alerted by imperfect prediction signal before hard failure. Based on an illustration example of offshore wind farm, in this paper three maintenance strategies are considered: periodic routine, reactive and opportunistic maintenance. The periodic routine maintenance is scheduled at fixed period for each individual system in the perspective of system of systems. Between two successive routine maintenances, the reactive maintenance is instructed by the imperfect prediction signal according to two criterion proposed in this study for the system components. Due to the high setup cost and practical restraints of implementing maintenance activities, both routine and reactive maintenance can create the opportunities of maintenance for the other components of an individual system. The life cycle of the system and the cost of the proposed maintenance policies are analytically derived. Restrained by the complexity from both the system failure modelling and maintenance strategies, the performances and application scope of the proposed maintenance model are evaluated by numerical simulations. - Highlights: • We study the life behavior of a complex system with two failure modes. • We consider the imperfect prediction signal of potential failure by monitoring. • We propose an integrated maintenance policy with three levels based on wind turbine. • We derive the mathematical cost formulations for the proposed maintenance policy.

  4. Failure of policy regarding smoke-free bars in the Netherlands.

    Science.gov (United States)

    Gonzalez, Mariaelena; Glantz, Stanton A

    2013-02-01

    Tobacco companies consistently work to prevent and undermine smoke-free laws. The tobacco industry and its allies have funded hospitality associations and other third parties to oppose smoke-free laws, argue that smoke-free laws will economically damage hospitality venues, promote ventilation and voluntary smoker 'accommodation' as an alternative to smoke-free laws, and to challenge smoke-free laws in court. In 2008, the Netherlands extended its smoke-free law to hospitality venues. We triangulated news articles, government documents, scientific papers, statistical reports and interviews to construct this case study. Despite widespread public support for smoke-free hospitality venues, opponents successfully represented these laws as unpopular and damaging to small bars. These challenges and related smokers' rights activities resulted in non-compliance among all bars and reinstating an exemption for small, owner-run venues. This policy reversal was the result of a weak implementing media campaign (which failed to present the law as protecting nonsmokers), smoking room exemptions and reactive (vs. proactive) measures by the Ministry of Health and civil society. The policy failure in the Netherlands is the result of poor implementation efforts and the failure to anticipate and deal with opposition to the law. When implementing smoke-free laws it is important to anticipate opposition, used the media to target non-smokers to reinforce public support, and actively enforce the law.

  5. Failure of policy regarding smoke-free bars in the Netherlands*

    Science.gov (United States)

    Gonzalez, Mariaelena

    2013-01-01

    Background: Tobacco companies consistently work to prevent and undermine smoke-free laws. The tobacco industry and its allies have funded hospitality associations and other third parties to oppose smoke-free laws, argue that smoke-free laws will economically damage hospitality venues, promote ventilation and voluntary smoker ‘accommodation’ as an alternative to smoke-free laws, and to challenge smoke-free laws in court. In 2008, the Netherlands extended its smoke-free law to hospitality venues. Methods: We triangulated news articles, government documents, scientific papers, statistical reports and interviews to construct this case study. Results: Despite widespread public support for smoke-free hospitality venues, opponents successfully represented these laws as unpopular and damaging to small bars. These challenges and related smokers’ rights activities resulted in non-compliance among all bars and reinstating an exemption for small, owner-run venues. This policy reversal was the result of a weak implementing media campaign (which failed to present the law as protecting nonsmokers), smoking room exemptions and reactive (vs. proactive) measures by the Ministry of Health and civil society. Conclusion: The policy failure in the Netherlands is the result of poor implementation efforts and the failure to anticipate and deal with opposition to the law. When implementing smoke-free laws it is important to anticipate opposition, used the media to target non-smokers to reinforce public support, and actively enforce the law. PMID:22143826

  6. Advances in the treatment of acute liver failure

    Directory of Open Access Journals (Sweden)

    LUO Ling

    2018-02-01

    Full Text Available Acute liver failure (ALF is a rare life-threatening disease with rapid progression and a low survival rate and affects the function of multiple organ systems. Early identification of cause and protection of vital organs are critical for patients' survival. With the development in artificial liver, stem cell transplantation, and liver transplantation in recent years, the outcome of ALF has been greatly improved. This article elaborates on the treatment of ALF from the aspects of the etiology of ALF and major organ systems involved and introduces the latest advances in artificial liver and stem cell transplantation.

  7. Classes of Heart Failure

    Science.gov (United States)

    ... Introduction Types of Heart Failure Classes of Heart Failure Heart Failure in Children Advanced Heart Failure • Causes and ... and Advanced HF • Tools and Resources • Personal Stories Heart Failure Questions to Ask Your Doctor Use these questions ...

  8. [Implantable sensors for outpatient assessment of ventricular filling pressure in advanced heart failure : Which telemonitoring design is optimal?

    Science.gov (United States)

    Herrmann, E; Fichtlscherer, S; Hohnloser, S H; Zeiher, A M; Aßmus, B

    2016-12-01

    Patients with advanced heart failure suffer from frequent hospitalizations. Non-invasive hemodynamic telemonitoring for assessment of ventricular filling pressure has been shown to reduce hospitalizations. We report on the right ventricular (RVP), the pulmonary artery (PAP) and the left atrial pressure (LAP) sensor for non-invasive assessment of the ventricular filling pressure. A literature search concerning the available implantable pressure sensors for noninvasive haemodynamic telemonitoring in patients with advanced heart failure was performed. Until now, only implantation of the PAP-sensor was able to reduce hospitalizations for cardiac decompensation and to improve quality of life. The right ventricular pressure sensor missed the primary endpoint of a significant reduction of hospitalizations, clinical data using the left atrial pressure sensor are still pending. The implantation of a pressure sensor for assessment of pulmonary artery filling pressure is suitable for reducing hospitalizations for heart failure and for improving quality of life in patients with advanced heart failure.

  9. Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers.

    Science.gov (United States)

    Agha, Syed A; Kalogeropoulos, Andreas P; Shih, Jeffrey; Georgiopoulou, Vasiliki V; Giamouzis, Grigorios; Anarado, Perry; Mangalat, Deepa; Hussain, Imad; Book, Wendy; Laskar, Sonjoy; Smith, Andrew L; Martin, Randolph; Butler, Javed

    2009-09-01

    Incremental value of echocardiography over clinical parameters for outcome prediction in advanced heart failure (HF) is not well established. We evaluated 223 patients with advanced HF receiving optimal therapy (91.9% angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 92.8% beta-blockers, 71.8% biventricular pacemaker, and/or defibrillator use). The Seattle Heart Failure Model (SHFM) was used as the reference clinical risk prediction scheme. The incremental value of echocardiographic parameters for event prediction (death or urgent heart transplantation) was measured by the improvement in fit and discrimination achieved by addition of standard echocardiographic parameters to the SHFM. After a median follow-up of 2.4 years, there were 38 (17.0%) events (35 deaths; 3 urgent transplants). The SHFM had likelihood ratio (LR) chi(2) 32.0 and C statistic 0.756 for event prediction. Left ventricular end-systolic volume, stroke volume, and severe tricuspid regurgitation were independent echocardiographic predictors of events. The addition of these parameters to SHFM improved LR chi(2) to 72.0 and C statistic to 0.866 (P advanced HF.

  10. Innovation in Citizen Science – Perspectives on Science-Policy Advances

    Directory of Open Access Journals (Sweden)

    Susanne Hecker

    2018-04-01

    Full Text Available Citizen science is growing as a field of research with contributions from diverse disciplines, promoting innovation in science, society, and policy. Inter- and transdisciplinary discussions and critical analyses are needed to use the current momentum to evaluate, demonstrate, and build on the advances that have been made in the past few years. This paper synthesizes results of discussions at the first international citizen science conference of the European Citizen Science Association (ECSA in 2016 in Berlin, Germany, and distills major points of the discourse into key recommendations. To enhance innovation in science, citizen science needs to clearly demonstrate its scientific benefit, branch out across disciplines, and foster active networking and new formats of collaboration, including true co-design with participants. For fostering policy advances, it is important to embrace opportunities for policy-relevant monitoring and policy development and to work with science funders to find adequate avenues and evaluation tools to support citizen science. From a society angle it is crucial to engage with societal actors in various formats that suit participants and to evaluate two-way learning outcomes as well as to develop the transformative role of science communication. We hope that these key perspectives will promote citizen science progress at the science-society-policy interface.

  11. Heart Transplant and Mechanical Circulatory Support in Patients With Advanced Heart Failure.

    Science.gov (United States)

    Sánchez-Enrique, Cristina; Jorde, Ulrich P; González-Costello, José

    2017-05-01

    Patients with advanced heart failure have a poor prognosis and heart transplant is still the best treatment option. However, the scarcity of donors, long waiting times, and an increasing number of unstable patients have favored the development of mechanical circulatory support. This review summarizes the indications for heart transplant, candidate evaluation, current immunosuppression strategies, the evaluation and treatment of rejection, infectious prophylaxis, and short and long-term outcomes. Regarding mechanical circulatory support, we distinguish between short- and long-term support and the distinct strategies that can be used: bridge to decision, recovery, candidacy, transplant, and destination therapy. We then discuss indications, risk assessment, management of complications, especially with long-term support, and outcomes. Finally, we discuss future challenges and how the widespread use of long-term support for patients with advanced heart failure will only be viable if their complications and costs are reduced. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  12. The National Strategic Plan of South Africa: what are the prospects of success after the repeated failure of previous AIDS policy?

    Science.gov (United States)

    Wouters, Edwin; van Rensburg, H C J; Meulemans, H

    2010-05-01

    Hitherto, the story of HIV/AIDS in South Africa is, to a large extent, one of lost opportunities. Whereas the country has one of the worst epidemics in the world, consecutive national AIDS strategies have been repeatedly marked by failure over almost three decades. Understandably, South Africa's most recent HIV/AIDS policy, the HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011 (NSP), has been greeted with general acclaim. However, what are its real prospects of success against the backdrop of the repeated failures of the past? The first objective of this review is to systematically identify the core reasons for past policy failures. Using a comprehensive analytical framework, this article presents a systematic review of the literature on postapartheid AIDS policy in South Africa. The analysis demonstrates that a complex interplay among the content, context, actors and process of AIDS policy created a gap between policy making and policy implementation, which rendered near-ideal AIDS policies ineffective. Secondly, we evaluate the chances of success of the current NSP by examining both the policy-making phase and the resulting policy document in light of the reasons for past policy failures. Our analysis shows that the NSP contains dynamic and comprehensive policy content, sensitive to the socio-economic and cultural dimensions of HIV/AIDS. However, many of the political actors that hampered treatment implementation in the past, and who deepened the gap between government and civil society, are still in office. Monetary and human resource shortages also create a policy context that is infertile for the implementation of a comprehensive HIV/AIDS strategy, as envisaged in the NSP. Finally, these health system restrictions have a clear negative impact on the process of policy implementation. Without the mobilization of people living with HIV/AIDS and their communities, the NSP will be ineffective in bridging the gap between policy intentions and policy

  13. What lessons have been learned in reforming the Renewables Obligation? An analysis of internal and external failures in UK renewable energy policy

    International Nuclear Information System (INIS)

    Wood, Geoffrey; Dow, Stephen

    2011-01-01

    Despite operating a delivery programme for RES-E since 1990, UK targets and policy goals have not been achieved. In response, the Government reformed the RO. This article re-examines UK renewable energy policy by analysing the internal and external failures of the various mechanisms to determine if Government has learnt from previous experience in reforming the RO. Government did not learn from their own actions during the NFFO/RO transition, evidenced by high-levels of similarity in internal/external failures. The reformed-RO is expected to significantly increase deployment, has provided a 'renewables package' by comprehensively addressing both internal/external failures but major internal failures (price/financial risk) still remain, resulting in contiguous failures over two decades and two mechanism changes (NFFO, RO, RO/reformed-RO). Success will again be heavily dependent on a select few technologies and new/untested measures to combat external failures. Mechanism-extension to 2037 is probably the single most important factor underlying potential deployment increases. However, introducing a FIT-like system via the sheer number of 'bolt-on' reforms to counter policy failures indicates loss of direction and clarity. Overall, although Government appears to have learnt some of its lessons from the past two-decades, significant doubt remains whether renewable energy policy objectives will be met via the latest mechanism change. - Research highlights: → Review of UK renewable energy policy learning behaviour via the 2009 Renewable Obligation reform. → Applies key lessons and analysis of NFFO/RO, RO reform and possible FIT schemes. → Finds UK Government has learnt some lessons from the past but some failures remain contiguous over two decades. → In contrast to previous changes, 2009 reform provided a comprehensive reform package. → Significant doubt remains whether objectives will be met via latest mechanism change.

  14. NHLBI's program for VAD therapy for moderately advanced heart failure: the REVIVE-IT pilot trial.

    Science.gov (United States)

    Baldwin, J Timothy; Mann, Douglas L

    2010-11-01

    Ventricular assist devices (VADs) are used to bridge heart failure patients to transplantation, to allow their own hearts to recover, or as permanent ("destination") therapy. To date, the use of VADs has been limited to late-stage heart failure patients because of the associated device risks. In 2008, a National Heart, Lung, and Blood Institute (NHLBI) working group met to evaluate the treatment of heart failure using VADs and to advise the institute on how therapy for heart failure may be best advanced by clinical trials involving the devices. Recognizing the improvements in VAD technology and in patient care and selection over the past decade, the working group recommended that a trial be performed to assess the use of chronic VAD therapy in patients who are less ill than those currently eligible for destination therapy. The hypothesis proposed for the trial is that VAD therapy may improve both survival and quality of life in moderately advanced heart failure patients who are neither inotrope-dependent nor exercise-intolerant and have not yet developed serious consequences such as malnourishment, end-organ damage, and immobility. Based on the group's recommendations, NHLBI issued an RFP in 2009 for the REVIVE-IT Pilot Trail, which will serve to test the hypothesis and inform the pivotal trial. Published by Elsevier Inc.

  15. Policies for advancing energy efficiency and renewable energy use in Brazil

    International Nuclear Information System (INIS)

    Geller, Howard; Schaeffer, Roberto; Szklo, Alexandre; Tolmasquim, Mauricio

    2004-01-01

    This article first reviews energy trends and energy policy objectives in Brazil. It then proposes and analyzes 12 policy options for advancing energy efficiency and renewable energy use. The policies are analyzed as a group with respect to their impacts on total energy supply and demand as well as CO 2 emissions. It is determined that the policies would provide a broad range of benefits for Brazil including reducing investment requirements in the energy sector, cutting energy imports, lowering CO 2 emissions, and providing social benefits. (Author)

  16. Intravenous Milrinone in Treatment of Advanced Congestive Heart Failure

    Science.gov (United States)

    Zewail, Aly M.; Nawar, Mohammad; Vrtovec, Bojan; Eastwood, Cathy; Kar, Biswajit; Delgado, Reynolds M.

    2003-01-01

    Phosphodiesterase inhibitors such as milrinone can relieve symptoms and improve hemodynamics in patients with advanced congestive heart failure. We retrospectively evaluated the hemodynamic and clinical outcomes of long-term combination therapy with intravenous milrinone and oral β-blockers in 65 patients with severe congestive heart failure (New York Heart Association class IV function and ejection fraction milrinone. Oral medical therapy was maximized when possible. The mean duration of milrinone treatment in this combination-treatment group was 269 days (range, 14–1,026 days). Functional class improved from IV to II–III with milrinone therapy. Twenty-four such patients tolerated β-blocker up-titration and were successfully weaned from milrinone. Sixteen patients (31%) died while receiving combination therapy; one died of sudden cardiac death (on treatment day 116); the other 15 died of progressive heart failure or other complications. Hospital admissions during the previous 6 months and admissions within 6 months after milrinone initiation stayed the same. Meanwhile, the total number of hospital days decreased from 450 to 380 (a 15.6% reduction), and the mean length of stay decreased by 1.4 days (a 14.7% reduction). We conclude that 1) milrinone plus β-blocker combination therapy is an effective treatment for heart failure even with β-blocker up-titration, 2) weaning from milrinone may be possible once medications are maximized, 3) patients' functional status improves on the combination regimen, and 4) treatment-related sudden death is relatively infrequent during the combination regimen. (Tex Heart Inst J 2003;30:109–13) PMID:12809251

  17. Career cartography: a conceptualization of career development to advance health and policy.

    Science.gov (United States)

    Feetham, Suzanne; Doering, Jennifer J

    2015-01-01

    The purpose of this article is to propose a conceptualization of career development that emphasizes the interdependence between research, practice, and policy. Career cartography applies three decades of career development experience to lay out a systematic, comprehensive, and iterative approach for planning and communicating the outcomes of science at any career stage. To inform practice and policy, nurse researchers must be clear on the intended destination and trajectory of the science, and be skilled in communicating that science and vision to diverse stakeholders. Career cartography builds on the science of cartography, is developed within the context of public and health policy, and is composed of several components, including a destination statement, career mapping, a supportive career cartography team, and use of communication and dissemination strategies. The successful utilization of career cartography may accelerate advancement of individual careers, scientific impact, and the discipline as a whole by guiding nurse researchers to be deliberative in career planning and to communicate successfully the outcomes of research across a wide variety of stakeholders. Career cartography provides a framework for planning a nurse researcher's program of research and scholarship to advance science, policy, and health of the public. Career cartography guides nurse researchers to realize their full potential to advance the health of the public and inform public and health policy in academic and practice environments. © 2014 Sigma Theta Tau International.

  18. Evaluating Energy Efficiency Policies with Energy-Economy Models

    Energy Technology Data Exchange (ETDEWEB)

    Mundaca, Luis; Neij, Lena; Worrell, Ernst; McNeil, Michael A.

    2010-08-01

    The growing complexities of energy systems, environmental problems and technology markets are driving and testing most energy-economy models to their limits. To further advance bottom-up models from a multidisciplinary energy efficiency policy evaluation perspective, we review and critically analyse bottom-up energy-economy models and corresponding evaluation studies on energy efficiency policies to induce technological change. We use the household sector as a case study. Our analysis focuses on decision frameworks for technology choice, type of evaluation being carried out, treatment of market and behavioural failures, evaluated policy instruments, and key determinants used to mimic policy instruments. Although the review confirms criticism related to energy-economy models (e.g. unrealistic representation of decision-making by consumers when choosing technologies), they provide valuable guidance for policy evaluation related to energy efficiency. Different areas to further advance models remain open, particularly related to modelling issues, techno-economic and environmental aspects, behavioural determinants, and policy considerations.

  19. Optimal selective renewal policy for systems subject to propagated failures with global effect and failure isolation phenomena

    International Nuclear Information System (INIS)

    Maaroufi, Ghofrane; Chelbi, Anis; Rezg, Nidhal

    2013-01-01

    This paper considers a selective maintenance policy for multi-component systems for which a minimum level of reliability is required for each mission. Such systems need to be maintained between consecutive missions. The proposed strategy aims at selecting the components to be maintained (renewed) after the completion of each mission such that a required reliability level is warranted up to the next stop with the minimum cost, taking into account the time period allotted for maintenance between missions and the possibility to extend it while paying a penalty cost. This strategy is applied to binary-state systems subject to propagated failures with global effect, and failure isolation phenomena. A set of rules to reduce the solutions space for such complex systems is developed. A numerical example is presented to illustrate the modeling approach and the use of the reduction rules. Finally, the Monte-Carlo simulation is used in combination with the selective maintenance optimization model to deal with a number of successive missions

  20. Glucose Homeostasis, Pancreatic Endocrine Function, and Outcomes in Advanced Heart Failure.

    Science.gov (United States)

    Melenovsky, Vojtech; Benes, Jan; Franekova, Janka; Kovar, Jan; Borlaug, Barry A; Segetova, Marketa; Tura, Andrea; Pelikanova, Tereza

    2017-08-07

    The mechanisms and relevance of impaired glucose homeostasis in advanced heart failure (HF) are poorly understood. The study goals were to examine glucose regulation, pancreatic endocrine function, and metabolic factors related to prognosis in patients with nondiabetic advanced HF. In total, 140 advanced HF patients without known diabetes mellitus and 21 sex-, age-, and body mass index-matched controls underwent body composition assessment, oral glucose tolerance testing, and measurement of glucose-regulating hormones to model pancreatic β-cell secretory response. Compared with controls, HF patients had similar fasting glucose and insulin levels but higher levels after oral glucose tolerance testing. Insulin secretion was not impaired, but with increasing HF severity, there was a reduction in glucose, insulin, and insulin/glucagon ratio-a signature of starvation. The insulin/C-peptide ratio was decreased in HF, indicating enhanced insulin clearance, and this was correlated with lower cardiac output, hepatic insufficiency, right ventricular dysfunction, and body wasting. After a median of 449 days, 41% of patients experienced an adverse event (death, urgent transplant, or assist device). Increased glucagon and, paradoxically, low fasting plasma glucose displayed the strongest relations to outcome ( P =0.01). Patients in the lowest quartile of fasting plasma glucose (3.8-5.1 mmol·L -1 , 68-101 mg·dL -1 ) had 3-times higher event risk than in the top quartile (6.0-7.9 mmol·L -1 , 108-142 mg·dL -1 ; relative risk: 3.05 [95% confidence interval, 1.46-6.77]; P =0.002). Low fasting plasma glucose and increased glucagon are robust metabolic predictors of adverse events in advanced HF. Pancreatic insulin secretion is preserved in advanced HF, but levels decrease with increasing HF severity due to enhanced insulin clearance that is coupled with right heart failure and cardiac cachexia. © 2017 The Authors. Published on behalf of the American Heart Association, Inc

  1. Investigating reservation policies of advance orders in the presence of heterogeneous demand

    DEFF Research Database (Denmark)

    Du, Bisheng; Larsen, Christian

    We consider an inventory system, operated by a base stock policy and serving two customer classes. One customer class, Class 1, does not provide any advance demand information at all, while the other, Class 2, does. In order to reward a customer of Class 2 for providing advance order information......, it may be sensible to make reservations for the order in the inventory system, thereby preventing later arriving orders from getting access to the inventory before this particular order. We propose various reservation policies and study their impact on the performance of the inventory system....

  2. Improving Decision Making for Advanced Heart Failure Patients and Caregivers.

    Science.gov (United States)

    McIlvennan, Colleen K

    2017-04-01

    In this month's Magnet® Perspectives column, Colleen K. McIlvennan, DNP, ANP, lead nurse practitioner, Advanced Heart Failure and Transplantation at the University of Colorado, discusses her groundbreaking research encompassing patients' and caregivers' emotional, rational, and fundamental beliefs when considering a left ventricular assist device (LVAD). Results have led to the development of 2 innovative decision aids that are currently in use by LVAD programs across the United States and Canada. Dr McIlvennan's efforts led to a $2 million grant from the Patient-Centered Outcomes Research Institute, as well as national recognition from the American Heart Association and the Heart Failure Society of America. Last year, she received the 2016 National Magnet Nurse of the Year® Award in the Empirical Outcomes category. In addition to sharing her findings, Dr McIlvennan examines the value of performing research in a Magnet-recognized organization.

  3. Patient-Clinician Communication About End-of-Life Care in Patients With Advanced Chronic Organ Failure During One Year.

    Science.gov (United States)

    Houben, Carmen H M; Spruit, Martijn A; Schols, Jos M G A; Wouters, Emiel F M; Janssen, Daisy J A

    2015-06-01

    Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure. The aim was to examine the quality of end-of-life care communication during one year follow-up of patients with advanced chronic organ failure. In addition, we aimed to explore whether and to what extent quality of communication about end-of-life care changes toward the end of life and whether end-of-life care communication is related to patient-perceived quality of medical care. Clinically stable outpatients (n = 265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess quality of end-of-life care communication (Quality of Communication questionnaire). Two years after baseline, survival status was assessed, and if patients died during the study period, a bereavement interview was done with the closest relative. One year follow-up was completed by 77.7% of the patients. Quality of end-of-life care communication was rated low at baseline and did not change over one year. Quality of end-of-life care communication was comparable for patients who completed two year follow-up and patients who died during the study. The correlation between quality of end-of-life care communication and satisfaction with medical treatment was weak. End-of-life care communication is poor in patients with chronic organ failure and does not change toward the end of life. Future studies should develop an intervention aiming at initiating high-quality end-of-life care communication between patients with advanced chronic organ failure and their clinicians. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. An analysis of policy success and failure in formal evaluations of Australia's national mental health strategy (1992-2012).

    Science.gov (United States)

    Grace, Francesca C; Meurk, Carla S; Head, Brian W; Hall, Wayne D; Harris, Meredith G; Whiteford, Harvey A

    2017-05-30

    Heightened fiscal constraints, increases in the chronic disease burden and in consumer expectations are among several factors contributing to the global interest in evidence-informed health policy. The present article builds on previous work that explored how the Australian Federal Government applied five instruments of policy, or policy levers, to implement a series of reforms under the Australian National Mental Health Strategy (NMHS). The present article draws on theoretical insights from political science to analyse the relative successes and failures of these levers, as portrayed in formal government evaluations of the NMHS. Documentary analysis of six evaluation documents corresponding to three National Mental Health Plans was undertaken. Both the content and approach of these government-funded, independently conducted evaluations were appraised. An overall improvement was apparent in the development and application of policy levers over time. However, this finding should be interpreted with caution due to variations in evaluation approach according to Plan and policy lever. Tabulated summaries of the success and failure of each policy initiative, ordered by lever type, are provided to establish a resource that could be consulted for future policy-making. This analysis highlights the complexities of health service reform and underscores the limitations of narrowly focused empirical approaches. A theoretical framework is provided that could inform the evaluation and targeted selection of appropriate policy levers in mental health.

  5. NHLBI’s Program for VAD Therapy for Moderately Advanced Heart Failure: The REVIVE-IT Pilot Trial

    Science.gov (United States)

    Baldwin, J. Timothy; Mann, Douglas L.

    2010-01-01

    Background VADs are used to bridge heart failure patients to transplantation, to allow their own hearts to recover, or as permanent (“destination”) therapy. To date, the use of VADs has been limited to late-stage heart failure patients because of the associated device risks. In 2008, an NHLBI working group met to evaluate the treatment of heart failure using VADs and to advise the institute on how therapy for heart failure may be best advanced by clinical trials involving the devices. Discussion and Recommendations Recognizing the improvements in VAD technology and in patient care and selection over the past decade, the working group recommended that a trial be performed to assess the use of chronic VAD therapy in patients who are less ill than those currently eligible for destination therapy. The hypothesis proposed for the trial is that VAD therapy may improve both survival and quality of life in moderately advanced heart failure patients who are neither inotrope-dependent nor exercise-intolerant and have not yet developed serious consequences such as malnourishment, end-organ damage, and immobility. Based on the group’s recommendations, NHLBI issued an RFP in 2009 for the REVIVE-IT Pilot Trail which will serve to test the hypothesis and inform the pivotal trial. PMID:21055648

  6. A peripheral blood transcriptome biomarker test to diagnose functional recovery potential in advanced heart failure.

    Science.gov (United States)

    Deng, Mario C

    2018-05-08

    Heart failure (HF) is a complex clinical syndrome that causes systemic hypoperfusion and failure to meet the body's metabolic demands. In an attempt to compensate, chronic upregulation of the sympathetic nervous system and renin-angiotensin-aldosterone leads to further myocardial injury, HF progression and reduced O 2 delivery. This triggers progressive organ dysfunction, immune system activation and profound metabolic derangements, creating a milieu similar to other chronic systemic diseases and presenting as advanced HF with severely limited prognosis. We hypothesize that 1-year survival in advanced HF is linked to functional recovery potential (FRP), a novel clinical composite parameter that includes HF severity, secondary organ dysfunction, co-morbidities, frailty, disabilities as well as chronological age and that can be diagnosed by a molecular biomarker.

  7. Environmental and technology policy options in the electricity sector. Interactions and outcomes

    International Nuclear Information System (INIS)

    Fischer, Carolyn; Newell, Richard G.; Preonas, Louis

    2014-01-01

    Myriad policy measures aim to reduce greenhouse gas emissions from the electricity sector, promote generation from renewable sources, and encourage energy conservation. To what extent do innovation and energy efficiency (EE) market failures justify additional interventions when a carbon price is in place? We extend the model of Fischer and Newell (2008) with advanced and conventional renewable energy technologies and short and long-run EE investments. We incorporate both knowledge spillovers and imperfections in the demand for energy efficiency. We conclude that some technology policies, particularly correcting R and D market failures, can be useful complements to emissions pricing, but ambitious renewable targets or subsidies seem unlikely to enhance welfare when placed alongside sufficient emissions pricing. The desirability of stringent EE policies is highly sensitive to the degree of undervaluation of EE by consumers, which also has implications for policies that tend to lower electricity prices. Even with multiple market failures, emissions pricing remains the single most cost-effective option for reducing emissions.

  8. Environmental and technology policy options in the electricity sector. Interactions and outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Carolyn [Resources for the Future, Inc., Washington, DC (United States); Newell, Richard G. [Duke Univ., Durham, NC (United States); Preonas, Louis [California Univ., Berkeley, CA (United States); Resources for the Future, Inc., Washington, DC (United States)

    2014-04-15

    Myriad policy measures aim to reduce greenhouse gas emissions from the electricity sector, promote generation from renewable sources, and encourage energy conservation. To what extent do innovation and energy efficiency (EE) market failures justify additional interventions when a carbon price is in place? We extend the model of Fischer and Newell (2008) with advanced and conventional renewable energy technologies and short and long-run EE investments. We incorporate both knowledge spillovers and imperfections in the demand for energy efficiency. We conclude that some technology policies, particularly correcting R and D market failures, can be useful complements to emissions pricing, but ambitious renewable targets or subsidies seem unlikely to enhance welfare when placed alongside sufficient emissions pricing. The desirability of stringent EE policies is highly sensitive to the degree of undervaluation of EE by consumers, which also has implications for policies that tend to lower electricity prices. Even with multiple market failures, emissions pricing remains the single most cost-effective option for reducing emissions.

  9. Advances in risk assessment for climate change adaptation policy.

    Science.gov (United States)

    Adger, W Neil; Brown, Iain; Surminski, Swenja

    2018-06-13

    Climate change risk assessment involves formal analysis of the consequences, likelihoods and responses to the impacts of climate change and the options for addressing these under societal constraints. Conventional approaches to risk assessment are challenged by the significant temporal and spatial dynamics of climate change; by the amplification of risks through societal preferences and values; and through the interaction of multiple risk factors. This paper introduces the theme issue by reviewing the current practice and frontiers of climate change risk assessment, with specific emphasis on the development of adaptation policy that aims to manage those risks. These frontiers include integrated assessments, dealing with climate risks across borders and scales, addressing systemic risks, and innovative co-production methods to prioritize solutions to climate challenges with decision-makers. By reviewing recent developments in the use of large-scale risk assessment for adaptation policy-making, we suggest a forward-looking research agenda to meet ongoing strategic policy requirements in local, national and international contexts.This article is part of the theme issue 'Advances in risk assessment for climate change adaptation policy'. © 2018 The Author(s).

  10. Advances in risk assessment for climate change adaptation policy

    Science.gov (United States)

    Adger, W. Neil; Brown, Iain; Surminski, Swenja

    2018-06-01

    Climate change risk assessment involves formal analysis of the consequences, likelihoods and responses to the impacts of climate change and the options for addressing these under societal constraints. Conventional approaches to risk assessment are challenged by the significant temporal and spatial dynamics of climate change; by the amplification of risks through societal preferences and values; and through the interaction of multiple risk factors. This paper introduces the theme issue by reviewing the current practice and frontiers of climate change risk assessment, with specific emphasis on the development of adaptation policy that aims to manage those risks. These frontiers include integrated assessments, dealing with climate risks across borders and scales, addressing systemic risks, and innovative co-production methods to prioritize solutions to climate challenges with decision-makers. By reviewing recent developments in the use of large-scale risk assessment for adaptation policy-making, we suggest a forward-looking research agenda to meet ongoing strategic policy requirements in local, national and international contexts. This article is part of the theme issue `Advances in risk assessment for climate change adaptation policy'.

  11. Efficacy of tegafur-uracil in advanced urothelial cancer patients after the treatment failure of platinum-based chemotherapy.

    Science.gov (United States)

    Maolake, Aerken; Izumi, Kouji; Takahashi, Rie; Itai, Shingo; Machioka, Kazuaki; Yaegashi, Hiroshi; Nohara, Takahiro; Kitagawa, Yasuhide; Kadono, Yoshifumi; Konaka, Hiroyuki; Mizokami, Atsushi; Namiki, Mikio

    2015-03-01

    Platinum-based chemotherapy is the first-line treatment for advanced urinary tract urothelial cancers. However, the optimal second-line treatment is unclear. Although tegafur-uracil is sometimes used for advanced urothelial cancer patients after the treatment failure of platinum-based chemotherapy, there is little evidence regarding its use as a second-line treatment. Advanced urothelial cancer patients previously treated with platinum-based chemotherapy were retrospectively analyzed. Overall survival (OS) was compared between patients with and without tegafur-uracil treatment. Thirty-one patients (27 and 4 patients with and without tegafur-uracil treatment, respectively) were analyzed. OS from the last day of the final chemotherapy course was better in patients with tegafur-uracil treatment than in those without (p<0.001, 358 and 66.5 days of the median survival time, respectively). Tegafur-uracil may be a candidate for the secondary treatment of advanced urothelial cancer patients after the treatment failure of platinum-based chemotherapy. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  12. Nursing home policies regarding advance care planning in Flanders, Belgium

    NARCIS (Netherlands)

    de Gendt, C.; Bilsen, J.; van der Stichele, R.; Deliens, L.

    2010-01-01

    Background: The aim of this study is to discover how many nursing homes (NHs) in Flanders (Belgium) have policies on advance care planning (ACP) and their content regarding different medical end-of-life decisions. Methods: A structured mail questionnaire was sent to the NH administrators of all 594

  13. Do plasma concentrations of apelin predict prognosis in patients with advanced heart failure?

    Science.gov (United States)

    Dalzell, Jonathan R; Jackson, Colette E; Chong, Kwok S; McDonagh, Theresa A; Gardner, Roy S

    2014-01-01

    Apelin is an endogenous vasodilator and inotrope, plasma concentrations of which are reduced in advanced heart failure (HF). We determined the prognostic significance of plasma concentrations of apelin in advanced HF. Plasma concentrations of apelin were measured in 182 patients with advanced HF secondary to left ventricular systolic dysfunction. The predictive value of apelin for the primary end point of all-cause mortality was assessed over a median follow-up period of 544 (IQR: 196-923) days. In total, 30 patients (17%) reached the primary end point. Of those patients with a plasma apelin concentration above the median, 14 (16%) reached the primary end point compared with 16 (17%) of those with plasma apelin levels below the median (p = NS). NT-proBNP was the most powerful prognostic marker in this population (log rank statistic: 10.37; p = 0.001). Plasma apelin concentrations do not predict medium to long-term prognosis in patients with advanced HF secondary to left ventricular systolic dysfunction.

  14. Immediate challenge of combating climate change: Effective implementation of energy efficiency policies

    Energy Technology Data Exchange (ETDEWEB)

    Morvaj, Zoran; Bukarica, Vesna

    2010-09-15

    Energy efficiency is the most readily available, rapid and cost-effective way to achieve desired greenhouse gases reductions. Therefore, it is the focus of energy and climate change policies world wide. The results of these policies are still missing in the desired extent, even in the EU, which has the most advanced energy efficiency policy. The main reason behind this policy failure is a complete lack of focus on implementing capacities that would ensure full policy uptake. Embracing full-scale energy management systems in public and business sectors and mobilisation of and cooperation between all stakeholders are the way towards higher efficiency.

  15. Types of Heart Failure

    Science.gov (United States)

    ... Introduction Types of Heart Failure Classes of Heart Failure Heart Failure in Children Advanced Heart Failure • Causes and ... and procedures related to heart disease and stroke. Heart Failure Questions to Ask Your Doctor Use these questions ...

  16. Advancing LGBT Elder Policy and Support Services: The Massachusetts Model.

    Science.gov (United States)

    Krinsky, Lisa; Cahill, Sean R

    2017-12-01

    The Massachusetts-based LGBT Aging Project has trained elder service providers in affirming and culturally competent care for LGBT older adults, supported development of LGBT-friendly meal programs, and advanced LGBT equality under aging policy. Working across sectors, this innovative model launched the country's first statewide Legislative Commission on Lesbian, Gay, Bisexual, and Transgender Aging. Advocates are working with policymakers to implement key recommendations, including cultural competency training and data collection in statewide networks of elder services. The LGBT Aging Project's success provides a template for improving services and policy for LGBT older adults throughout the country.

  17. Failure analysis: Status and future trends

    International Nuclear Information System (INIS)

    Anderson, R.E.; Soden, J.M.; Henderson, C.L.

    1995-01-01

    Failure analysis is a critical element in the integrated circuit manufacturing industry. This paper reviews the changing role of failure analysis and describes major techniques employed in the industry today. Several advanced failure analysis techniques that meet the challenges imposed by advancements in integrated circuit technology are described and their applications are discussed. Future trends in failure analysis needed to keep pace with the continuing advancements in integrated circuit technology are anticipated

  18. Nuclear piping criteria for Advanced Light-Water Reactors, Volume 1--Failure mechanisms and corrective actions

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    This WRC Bulletin concentrates on the major failure mechanisms observed in nuclear power plant piping during the past three decades and on corrective actions taken to minimize or eliminate such failures. These corrective actions are applicable to both replacement piping and the next generation of light-water reactors. This WRC Bulletin was written with the objective of meeting a need for piping criteria in Advanced Light-Water Reactors, but there is application well beyond the LWR industry. This Volume, in particular, is equally applicable to current nuclear power plants, fossil-fueled power plants, and chemical plants including petrochemical. Implementation of the recommendations for mitigation of specific problems should minimize severe failures or cracking and provide substantial economic benefit. This volume uses a case history approach to high-light various failure mechanisms and the corrective actions used to resolve such failures. Particular attention is given to those mechanisms leading to severe piping failures, where severe denotes complete severance, large ''fishmouth'' failures, or long throughwall cracks releasing a minimum of 50 gpm. The major failure mechanisms causing severe failure are erosion-corrosion and vibrational fatigue. Stress corrosion cracking also has been a common problem in nuclear piping systems. In addition thermal fatigue due to mixing-tee and to thermal stratification also is discussed as is microbiologically-induced corrosion. Finally, water hammer, which represents the ultimate in internally-generated dynamic high-energy loads, is discussed

  19. Gene expression profiling reveals activation of the FA/BRCA pathway in advanced squamous cervical cancer with intrinsic resistance and therapy failure.

    Science.gov (United States)

    Balacescu, Ovidiu; Balacescu, Loredana; Tudoran, Oana; Todor, Nicolae; Rus, Meda; Buiga, Rares; Susman, Sergiu; Fetica, Bogdan; Pop, Laura; Maja, Laura; Visan, Simona; Ordeanu, Claudia; Berindan-Neagoe, Ioana; Nagy, Viorica

    2014-04-08

    Advanced squamous cervical cancer, one of the most commonly diagnosed cancers in women, still remains a major problem in oncology due to treatment failure and distant metastasis. Antitumor therapy failure is due to both intrinsic and acquired resistance; intrinsic resistance is often decisive for treatment response. In this study, we investigated the specific pathways and molecules responsible for baseline therapy failure in locally advanced squamous cervical cancer. Twenty-one patients with locally advanced squamous cell carcinoma were enrolled in this study. Primary biopsies harvested prior to therapy were analyzed for whole human gene expression (Agilent) based on the patient's 6 months clinical response. Ingenuity Pathway Analysis was used to investigate the altered molecular function and canonical pathways between the responding and non-responding patients. The microarray results were validated by qRT-PCR and immunohistochemistry. An additional set of 24 formalin-fixed paraffin-embedded cervical cancer samples was used for independent validation of the proteins of interest. A 2859-gene signature was identified to distinguish between responder and non-responder patients. 'DNA Replication, Recombination and Repair' represented one of the most important mechanisms activated in non-responsive cervical tumors, and the 'Role of BRCA1 in DNA Damage Response' was predicted to be the most significantly altered canonical pathway involved in intrinsic resistance (p = 1.86E-04, ratio = 0.262). Immunohistological staining confirmed increased expression of BRCA1, BRIP1, FANCD2 and RAD51 in non-responsive compared with responsive advanced squamous cervical cancer, both in the initial set of 21 cervical cancer samples and the second set of 24 samples. Our findings suggest that FA/BRCA pathway plays an important role in treatment failure in advanced cervical cancer. The assessment of FANCD2, RAD51, BRCA1 and BRIP1 nuclear proteins could provide important information about the

  20. Gene expression profiling reveals activation of the FA/BRCA pathway in advanced squamous cervical cancer with intrinsic resistance and therapy failure

    International Nuclear Information System (INIS)

    Balacescu, Ovidiu; Maja, Laura; Visan, Simona; Ordeanu, Claudia; Berindan-Neagoe, Ioana; Nagy, Viorica; Balacescu, Loredana; Tudoran, Oana; Todor, Nicolae; Rus, Meda; Buiga, Rares; Susman, Sergiu; Fetica, Bogdan; Pop, Laura

    2014-01-01

    Advanced squamous cervical cancer, one of the most commonly diagnosed cancers in women, still remains a major problem in oncology due to treatment failure and distant metastasis. Antitumor therapy failure is due to both intrinsic and acquired resistance; intrinsic resistance is often decisive for treatment response. In this study, we investigated the specific pathways and molecules responsible for baseline therapy failure in locally advanced squamous cervical cancer. Twenty-one patients with locally advanced squamous cell carcinoma were enrolled in this study. Primary biopsies harvested prior to therapy were analyzed for whole human gene expression (Agilent) based on the patient’s 6 months clinical response. Ingenuity Pathway Analysis was used to investigate the altered molecular function and canonical pathways between the responding and non-responding patients. The microarray results were validated by qRT-PCR and immunohistochemistry. An additional set of 24 formalin-fixed paraffin-embedded cervical cancer samples was used for independent validation of the proteins of interest. A 2859-gene signature was identified to distinguish between responder and non-responder patients. ‘DNA Replication, Recombination and Repair’ represented one of the most important mechanisms activated in non-responsive cervical tumors, and the ‘Role of BRCA1 in DNA Damage Response’ was predicted to be the most significantly altered canonical pathway involved in intrinsic resistance (p = 1.86E-04, ratio = 0.262). Immunohistological staining confirmed increased expression of BRCA1, BRIP1, FANCD2 and RAD51 in non-responsive compared with responsive advanced squamous cervical cancer, both in the initial set of 21 cervical cancer samples and the second set of 24 samples. Our findings suggest that FA/BRCA pathway plays an important role in treatment failure in advanced cervical cancer. The assessment of FANCD2, RAD51, BRCA1 and BRIP1 nuclear proteins could provide important information

  1. submitter CXCL$_{10}$ Is a Circulating Inflammatory Marker in Patients with Advanced Heart Failure: a Pilot Study

    CERN Document Server

    Altara, Raffaele; Hessel, Marleen H; Gu, Yumei; van Vark, Laura C; Akkerhuis, K Martijn; Staessen, Jan A; Struijker-Boudier, Harry A J; Booz, George W; Blankesteijn, W Matthijs

    2016-01-01

    Chemokines are involved in the remodeling of the heart; however, their significance as biomarkers in heart failure is unknown. We observed that circulating CXCR3 receptor chemokines CXCL9 and CXCL10 in a rat model of heart failure were increased 1 week after myocardial infarction. CXCL10 was also increased in both remote and infarcted regions of the heart and remained elevated at 16 weeks; CXCL9 was elevated in the remote area at 1 week. In humans, hierarchical clustering and principal component analysis revealed that circulating CXCL10, MIP-1α, and CD40 ligand were the best indicators for differentiating healthy and heart failure subjects. Serum CXCL10 levels were increased in patients with symptomatic heart failure as indexed by NYHA classification II through IV. The presence of CXCL10, MIP-1α, and CD40 ligand appears to be dominant in patients with advanced heart failure. These findings identify a distinct profile of inflammatory mediators in heart failure patients

  2. Advances in Financial Risk Management and Economic Policy Uncertainty: An Overview

    NARCIS (Netherlands)

    S.M. Hammoudeh (Shawkat); M.J. McAleer (Michael)

    2014-01-01

    markdownabstract__Abstract__ Financial risk management is difficult at the best of times, but especially so in the presence of economic uncertainty and financial crises. The purpose of this special issue on “Advances in Financial Risk Management and Economic Policy Uncertainty” is to highlight

  3. Energy efficiency, market failures, and government policy

    International Nuclear Information System (INIS)

    Levine, M.D.; Koomey, J.G.; McMahon, J.E.; Sanstad, A.H.; Hirst, E.

    1994-03-01

    This paper presents a framework for evaluating engineering-economic evidence on the diffusion of energy efficiency improvements. Four examples are evaluated within this framework. The analysis provides evidence of market failures related to energy efficiency. Specific market failures that may impede the adoption of cost-effective energy efficiency are discussed. Two programs that have had a major impact in overcoming these market failures, utility DSM programs and appliance standards, are described

  4. Fusion: A necessary component of US energy policy

    International Nuclear Information System (INIS)

    Correll, D.L. Jr.

    1989-01-01

    US energy policy must ensure that its security, its economy, or its world leadership in technology development are not compromised by failure to meet the nation's electrical energy needs. Increased concerns over the greenhouse effect from fossil-fuel combustion mean that US energy policy must consider how electrical energy dependence on oil and coal can be lessened by conservation, renewable energy sources, and advanced energy options (nuclear fission, solar energy, and thermonuclear fusion). In determining how US energy policy is to respond to these issues, it will be necessary to consider what role each of the three advanced energy options might play, and to determine how these options can complement one another. This paper reviews and comments on the principal US studies and legislation that have addressed fusion since 1980, and then suggests a research, development, and demonstration program that is consistent with the conclusions of those prior authorities and that will allow us to determine how fusion technology can fit into a US energy policy that takes a balanced, long term view of US needs. 17 refs

  5. Base Stock Policy in a Join-Type Production Line with Advanced Demand Information

    Science.gov (United States)

    Hiraiwa, Mikihiko; Tsubouchi, Satoshi; Nakade, Koichi

    Production control such as the base stock policy, the kanban policy and the constant work-in-process policy in a serial production line has been studied by many researchers. Production lines, however, usually have fork-type, join-type or network-type figures. In addition, in most previous studies on production control, a finished product is required at the same time as arrival of demand at the system. Demand information is, however, informed before due date in practice. In this paper a join-type (assembly) production line under base stock control with advanced demand information in discrete time is analyzed. The recursive equations for the work-in-process are derived. The heuristic algorithm for finding appropriate base stock levels of all machines at short time is proposed and the effect of advanced demand information is examined by simulation with the proposed algorithm. It is shown that the inventory cost can decreases with little backlogs by using the appropriate amount of demand information and setting appropriate base stock levels.

  6. The Water-Energy-Food Nexus: Advancing Innovative, Policy-Relevant Methods

    Science.gov (United States)

    Crootof, A.; Albrecht, T.; Scott, C. A.

    2017-12-01

    The water-energy-food (WEF) nexus is rapidly expanding in scholarly literature and policy settings as a novel way to address complex Anthropocene challenges. The nexus approach aims to identify tradeoffs and synergies of water, energy, and food systems, internalize social and environmental impacts, and guide development of cross-sectoral policies. However, a primary limitation of the nexus approach is the absence - or gaps and inconsistent use - of adequate methods to advance an innovative and policy-relevant nexus approach. This paper presents an analytical framework to identify robust nexus methods that align with nexus thinking and highlights innovative nexus methods at the frontier. The current state of nexus methods was assessed with a systematic review of 245 journal articles and book chapters. This review revealed (a) use of specific and reproducible methods for nexus assessment is uncommon - less than one-third of the reviewed studies present explicit methods; (b) nexus methods frequently fall short of capturing interactions among water, energy, and food - the very concept they purport to address; (c) assessments strongly favor quantitative approaches - 70% use primarily quantitative tools; (d) use of social science methods is limited (26%); and (e) many nexus methods are confined to disciplinary silos - only about one-quarter combine methods from diverse disciplines and less than one-fifth utilize both quantitative and qualitative approaches. Despite some pitfalls of current nexus methods, there are a host of studies that offer innovative approaches to help quantify nexus linkages and interactions among sectors, conceptualize dynamic feedbacks, and support mixed method approaches to better understand WEF systems. Applying our analytical framework to all 245 studies, we identify, and analyze herein, seventeen studies that implement innovative multi-method and cross-scalar tools to demonstrate promising advances toward improved nexus assessment. This paper

  7. Advances in risk assessment for climate change adaptation policy

    Science.gov (United States)

    Adger, W. Neil; Brown, Iain; Surminski, Swenja

    2018-01-01

    Climate change risk assessment involves formal analysis of the consequences, likelihoods and responses to the impacts of climate change and the options for addressing these under societal constraints. Conventional approaches to risk assessment are challenged by the significant temporal and spatial dynamics of climate change; by the amplification of risks through societal preferences and values; and through the interaction of multiple risk factors. This paper introduces the theme issue by reviewing the current practice and frontiers of climate change risk assessment, with specific emphasis on the development of adaptation policy that aims to manage those risks. These frontiers include integrated assessments, dealing with climate risks across borders and scales, addressing systemic risks, and innovative co-production methods to prioritize solutions to climate challenges with decision-makers. By reviewing recent developments in the use of large-scale risk assessment for adaptation policy-making, we suggest a forward-looking research agenda to meet ongoing strategic policy requirements in local, national and international contexts. This article is part of the theme issue ‘Advances in risk assessment for climate change adaptation policy’. PMID:29712800

  8. Generic policy in Bulgaria: a policy of failure or success?

    Directory of Open Access Journals (Sweden)

    Assena Stoimenova

    2016-09-01

    Full Text Available Generic medicines play a key role in managing the financial resources for pharmaceuticals in every country. This study analysed the generic policy legislative framework in Bulgaria with the aim to identify whether the policy implementation can be considered successful in the light of an international review of such policies introduced in other countries, or on the contrary, it has failed to deliver the main benefits. Legislative analysis, desktop study and macroeconomic overview of the Bulgarian pharmaceutical market were included. The study showed that only 3 out of 11 important policy elements are implemented in the country. Bulgaria has one of the highest shares of generics, an average of 81.39% (volume, for the studied period (2006–2014. However, further research is needed to evaluate the success of the existing generic policy in Bulgaria, as the market share of generic drugs is not the only measure of the policy efficiency.

  9. Advanced metering policy development and influence structures: The case of Norway

    International Nuclear Information System (INIS)

    Inderberg, Tor Håkon

    2015-01-01

    Responding to a global trend of installing smart meters Norway has taken a route of full governmental and regulatory coordination. The article maps and analyses the main influences on the developments of Norwegian Advanced Metering policy. Based on 12 interviews and extensive document mapping the Norwegian policy developments are traced from about 1990 to 2014, divided into three phases: Before 2000, between 2000 and 2007, and after 2007. It finds that the main influence and push came from an increasingly united industry sector, fronted by the grid utilities with respective interest organizations. Policy change has been boosted by years of constrained supply, creating incentives for political action. Also developments at the EU level have been important for creating attention for smart meters, while consumer groups have been less influential. The national regulator NVE has adapted its policy process to include external expertise, in particular from the grid companies. The findings confirm that influence into policy processes is a matter of financial and organizational resources and expert knowledge. Of particular policy relevance is the weak organization of private consumer interests into these policy streams, which may be important for further policy development for distributed generation and regulation of private generation activities. -- Highlights: •Roll-out of smart meters is in Norway coordinated by national regulation. •Grid companies and related interest organizations has been most influential. •EU has provided informal pressure on smart meter policy. •Consumer interests have been less influential in the policy process

  10. Effects of alagebrium, an advanced glycation endproduct breaker, on exercise tolerance and cardiac function in patients with chronic heart failure

    NARCIS (Netherlands)

    Hartog, Jasper W. L.; Willemsen, Suzan; van Veldhuisen, Dirk J.; Posma, Jan L.; van Wijk, Leen M.; Hummel, Yoran M.; Hillege, Hans L.; Voors, Adriaan A.

    Aims Advanced glycation endproducts (AGEs) have been associated with the development and progression of chronic heart failure (CHF). Advanced glycation endproducts-crosslink breakers might be of benefit in HF, but only small-scale and uncontrolled data are available. Our aim was to conduct a

  11. Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

    Science.gov (United States)

    George, Susan; Leasure, A Renee

    2016-01-01

    Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care.

  12. Public Policy Failure and Fiasco in Education: Perspectives on the British Examinations Crises of 2000-2002 and Other Episodes since 1975

    Science.gov (United States)

    Richardson, William

    2007-01-01

    In recent years there has been a re-appraisal within political science of the characteristics of various kinds of public policy failure. At the same time, the political significance of education has grown in most liberal democracies. The present paper examines public policy in British education since the mid-1970s and asks: What goes wrong in…

  13. Apatinib plus icotinib in treating advanced non-small cell lung cancer after icotinib treatment failure: a retrospective study.

    Science.gov (United States)

    Xu, Jianping; Liu, Xiaoyan; Yang, Sheng; Zhang, Xiangru; Shi, Yuankai

    2017-01-01

    Treatment failure frequently occurs in patients with epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) who respond to EGFR tyrosine kinase inhibitors initially. This retrospective study tried to investigate the efficacy and safety of apatinib plus icotinib in patients with advanced NSCLC after icotinib treatment failure. This study comprised 27 patients with advanced NSCLC who had progressed after icotinib monotherapy. Initially, patients received oral icotinib (125 mg, tid) alone. When the disease progressed, they received icotinib plus apatinib (500 mg, qd, orally). Treatment was continued until disease progression, unacceptable toxicity or consent withdrawal. Followed up to December 2016, the median time of combined therapy was 7.47 months, and eight of 27 patients were dead. The median overall survival was not reached, and median progression-free survival (PFS) was 5.33 months (95% CI, 3.63-7.03 months). Moreover, the objective response rate (ORR) was 11.1%, and the disease control rate (DCR) was 81.5%. A total of 14 patients received combined therapy as the second-line treatment, and the ORR and DCR were 7.1% and 78.6%, respectively; 13 patients received drugs as the third- or later-line treatment, with an ORR and a DCR of 15.4% and 84.6%, respectively. In addition, 11 patients experienced icotinib monotherapy failure within 6 months with median PFS of 7.37 months, and 16 patients had progression after 6 months with median PFS of 2.60 months. The common drug-related toxic effects were hypertension (44.4%) and fatigue (37.0%). Apatinib plus icotinib is efficacious in treating patients with advanced NSCLC after icotinib treatment failure, with acceptable toxic effects.

  14. Your Heart Failure Healthcare Team

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Your Heart Failure Healthcare Team Updated:May 9,2017 Patients with ... to the Terms and Conditions and Privacy Policy Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  15. 41 CFR 301-71.300 - What is the policy governing the use of travel advances?

    Science.gov (United States)

    2010-07-01

    ... governing the use of travel advances? 301-71.300 Section 301-71.300 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Accounting for Travel Advances § 301-71.300 What is the policy...

  16. The Advanced Glaucoma Intervention Study (AGIS): 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty.

    Science.gov (United States)

    2002-10-01

    To investigate the association of pre-intervention and post-intervention patient and eye characteristics with failure of argon laser trabeculoplasty (ALT) and trabeculectomy. Cohort study of participants in the Advanced Glaucoma Intervention Study. This multicenter study took place between 1988 and 2001. Between 1988 and 1992, 789 eyes of 591 patients aged 35 to 80 years with advanced glaucoma were randomized into one of two surgical treatment sequences: argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy or trabeculectomy-ALT-trabeculectomy. Upon study-defined failure (based on maximum medications, sustained intraocular pressure (IOP) elevation, visual field defect, and disk rim deterioration) of each intervention, patients were offered the subsequent intervention. Potential follow-up was 8 to 13 years. This report is based on data from 779 eyes that had at least 3 months of follow-up. The main outcome measures are failure of ALT and trabeculectomy, whether as first or second interventions. Effect size is measured by the hazard ratio (HR) and its corresponding 95% confidence interval (CI) obtained from Cox multiple regression analysis, where HR corresponds to the coefficient of change in risk associated with a unit increase in a factor. For binary factors, this corresponds to the change in risk in eyes with the factor relative to the risk in eyes without the factor. Pre-intervention factors associated with failure of ALT are younger age (HR = 0.98, CI = 0.96-0.99, P =.009) and higher IOP (1.11, 1.08-1.15, P <.001). Pre-intervention factors associated with failure of trabeculectomy are younger age (HR = 0.97, CI = 0.95-0.99, P =.005) and higher IOP (1.04, 1.01-1.06, P =.002), as well as diabetes (2.86, 1.88-4.36, P <.001) and any postoperative complication (1.99, 1.35-2.93, P <.001). Individual postoperative complications significantly associated with increased risk of failure of trabeculectomy are elevated IOP (3.4, 1.9-6.1, P <.001) and marked

  17. The pharmacotherapy of the HeartMate II, a continuous flow left ventricular assist device, in patients with advanced heart failure: integration of disease, device, and drug.

    Science.gov (United States)

    Jennings, Douglas L; Chambers, Rachel M; Schillig, Jessica M

    2010-10-01

    Advanced heart failure continues to be a significant cause of morbidity and mortality in the US. Patients with advanced heart failure have a poor prognosis without cardiac transplantation. The use of left ventricular assist devices (LVADs) as destination therapy for these patients is therefore expected to increase in the coming years as technology advances. The HeartMate II, a continuous flow implantable device, is currently the only LVAD that has been approved by the Food and Drug Administration for destination therapy in patients with advanced heart failure. The pharmacotherapy associated with this device is very complex and, therefore, the need for expertly trained clinical pharmacists to care for this expanding patient population will also likely increase. Unfortunately, most pharmacists are unfamiliar with the effect of LVADs on the physiology and pharmacotherapy of a patient's heart failure. The purpose of this article is to give clinical pharmacists an introduction to the most common pharmacotherapeutic issues for patients with LVADs and present practical solutions for managing common drug therapy problems.

  18. Hospital policies on life-sustaining treatments and advance directives in Canada.

    OpenAIRE

    Rasooly, I; Lavery, J V; Urowitz, S; Choudhry, S; Seeman, N; Meslin, E M; Lowy, F H; Singer, P A

    1994-01-01

    OBJECTIVE: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. DESIGN: Cross-sectional mailed survey. SETTING: Canada. PARTICIPANTS: Chief executive officers or their designates at public general hospitals. MAIN OUTCOME MEASURES: Information regarding the exis...

  19. Effects of Liraglutide on Clinical Stability Among Patients With Advanced Heart Failure and Reduced Ejection Fraction

    Science.gov (United States)

    Margulies, Kenneth B.; Hernandez, Adrian F.; Redfield, Margaret M.; Givertz, Michael M.; Oliveira, Guilherme H.; Cole, Robert; Mann, Douglas L.; Whellan, David J.; Kiernan, Michael S.; Felker, G. Michael; McNulty, Steven E.; Anstrom, Kevin J.; Shah, Monica R.; Braunwald, Eugene; Cappola, Thomas P.

    2016-01-01

    IMPORTANCE Abnormal cardiac metabolism contributes to the pathophysiology of advanced heart failure with reduced left ventricular ejection fraction (LVEF). Glucagon-like peptide 1 (GLP-1) agonists have shown cardioprotective effects in early clinical studies of patients with advanced heart failure, irrespective of type 2 diabetes status. OBJECTIVE To test whether therapy with a GLP-1 agonist improves clinical stability following hospitalization for acute heart failure. DESIGN, SETTING, AND PARTICIPANTS Phase 2, double-blind, placebo-controlled randomized clinical trial of patients with established heart failure and reduced LVEF who were recently hospitalized. Patients were enrolled between August 2013 and March 2015 at 24 US sites. INTERVENTIONS The GLP-1 agonist liraglutide (n = 154) or placebo (n = 146) via a daily subcutaneous injection; study drug was advanced to a dosage of 1.8 mg/d during the first 30 days as tolerated and continued for 180 days. MAIN OUTCOMES AND MEASURES The primary end point was a global rank score in which all patients, regardless of treatment assignment, were ranked across 3 hierarchical tiers: time to death, time to rehospitalization for heart failure, and time-averaged proportional change in N-terminal pro-B-type natriuretic peptide level from baseline to 180 days. Higher values indicate better health (stability). Exploratory secondary outcomes included primary end point components, cardiac structure and function, 6-minute walk distance, quality of life, and combined events. RESULTS Among the 300 patients who were randomized (median age, 61 years [interquartile range {IQR}, 52–68 years]; 64 [21%] women; 178 [59%] with type 2 diabetes; median LVEF of 25% [IQR, 19%–33%]; median N-terminal pro-B-type natriuretic peptide level of 2049 pg/mL [IQR, 1054–4235 pg/mL]), 271 completed the study. Compared with placebo, liraglutide had no significant effect on the primary end point (mean rank of 146 for the liraglutide group vs 156 for the

  20. Advancement Flap for Treatment of Complex Cryptoglandular Anal Fistula: Prediction of Therapy Success or Failure Using Anamnestic and Clinical Parameters.

    Science.gov (United States)

    Boenicke, Lars; Karsten, Eduard; Zirngibl, Hubert; Ambe, Peter

    2017-09-01

    Multiple new procedures for treatment of complex anal fistula have been described in the past decades, but an ideal single technique has yet not been identified. Factors that predict the outcome are required to identify the best procedure for each individual patient. The aim of this study was to find those predictors for advancement flap at midterm follow-up. From 2012 to 2015 in a tertiary university clinic, all patients who underwent advancement flap for treatment of complex cryptoglandular fistula were prospectively enrolled. Pre- and postoperatively standardized anamnestic and clinical examinations were performed. Predictive factors for therapy failure were identified using univariate and multivariate analysis. Out of 65 patients, 61 (93%) completed all examinations and were included in the study. Therapy failure after a mean follow-up period of 25 months occurred in total n = 11 patients (18%). There was no significant disturbance of continence among the entire study cohort as shown by the incontinence score (preop 0.34 ± 0.91 pts., postop 0.37 ± 0.97 pts.; p = 0.59). Univariate analysis for risk factors for therapy failure revealed age (p = 0.004), history of surgical abscess drainage (p = 0.04), BMI (p = 0.002), suprasphincteric fistula (p = 0.019) and horseshoe abscess (p = 0.036) as independent parameters for therapy failure. During multivariate analysis, only history of surgical abscess drainage (OR = 8.09, p = 0.048, 95% CI 0.98-64.96), suprasphincteric fistula (OR = 6.83, p = 0.032, 95% CI 1.17-6.83) and BMI (OR = 1.23, p = 0.017, 95% CI 1.03-1.46) were independent parameters for therapy failure. Advancement flap for treatment of complex fistula is effective and has low risk of disturbed continence. BMI, suprasphincteric fistula and history of surgical abscess drainage are predictors for therapy failure.

  1. Evaluation of common mode failure of safety functions for limiting fault events

    International Nuclear Information System (INIS)

    Rezendes, J.P.; Hyde, A.W.

    2004-01-01

    The draft U.S. Nuclear Regulatory Commission (NRC) policy on digital protection system software requires all Advanced Light Water Reactors (ALWRs) to be evaluated assuming a hypothetical common mode failure (CMF) which incapacitates the normal automatic initiation of safety functions. The System 80 + ALWR has been evaluated for such hypothetical conditions. The results show that the diverse automatic and manual protective systems in System 80 + provide ample safety performance margins relative to core coolability, offsite radiological releases. Reactor Coolant System (RCS) pressurization and containment integrity. This deterministic evaluation served to quantify the significant inherent safety margins in the System 80 + Standard Plant design even in the event of this extremely low probability scenario of a common mode failure. (author)

  2. A periodic inspection and replacement policy for systems subject to competing failure modes due to degradation and traumatic events

    Energy Technology Data Exchange (ETDEWEB)

    Huynh, K.T., E-mail: tuan.huynh@utt.f [Universite de technologie de Troyes, Institut Charles Delaunay and STMR UMR CNRS 6279-12, rue Marie Curie, BP2060, 10010 Troyes cedex (France); Barros, A., E-mail: anne.barros@utt.f [Universite de technologie de Troyes, Institut Charles Delaunay and STMR UMR CNRS 6279-12, rue Marie Curie, BP2060, 10010 Troyes cedex (France); Berenguer, C., E-mail: christophe.berenguer@utt.f [Universite de technologie de Troyes, Institut Charles Delaunay and STMR UMR CNRS 6279-12, rue Marie Curie, BP2060, 10010 Troyes cedex (France); Castro, I.T., E-mail: inmatorres@unex.e [Departamento de Matematicas, Escuela Politecnica, 10071 Caceres (Spain)

    2011-04-15

    This paper deals with the condition-based maintenance of single-unit systems which are subject to the competing and dependent failures due deterioration and traumatic shock events. The main aim is to provide a model to assess the value of condition monitoring information for the maintenance decision-making. A condition-based periodic inspection/replacement policy is developed and compared with a benchmark time-based block replacement policy. Numerical results show that it is indeed useful to follow closely the actual evolution of the system to adapt the maintenance decisions to the true system state to improve the performance of maintenance policies. The analysis of the maintenance costs savings can be used to justify or not the choice to implement a policy based on condition monitoring information and to invest in condition monitoring devices.

  3. A periodic inspection and replacement policy for systems subject to competing failure modes due to degradation and traumatic events

    International Nuclear Information System (INIS)

    Huynh, K.T.; Barros, A.; Berenguer, C.; Castro, I.T.

    2011-01-01

    This paper deals with the condition-based maintenance of single-unit systems which are subject to the competing and dependent failures due deterioration and traumatic shock events. The main aim is to provide a model to assess the value of condition monitoring information for the maintenance decision-making. A condition-based periodic inspection/replacement policy is developed and compared with a benchmark time-based block replacement policy. Numerical results show that it is indeed useful to follow closely the actual evolution of the system to adapt the maintenance decisions to the true system state to improve the performance of maintenance policies. The analysis of the maintenance costs savings can be used to justify or not the choice to implement a policy based on condition monitoring information and to invest in condition monitoring devices.

  4. Home inotropic therapy in advanced heart failure: cost analysis and clinical outcomes.

    Science.gov (United States)

    Harjai, K J; Mehra, M R; Ventura, H O; Lapeyre, Y M; Murgo, J P; Stapleton, D D; Smart, F W

    1997-11-05

    This study was conducted to assess cost savings and clinical outcomes associated with the use of home i.v. inotropic therapy in patients with advanced (New York Heart Association [NYHA] class IV) heart failure. Retrospective analysis. Tertiary care referral center. Twenty-four patients (13 men, 11 women; age, 61+/-12 years) with left ventricular ejection fraction home i.v. inotropic therapy for at least 4 consecutive weeks between May 1994 and April 1996. Inotropic agents used included dobutamine (n=20; dose, 5.0+/-2.2 microg/kg/min) or milrinone (n=7; dose, 0.53+/-0.05 microg/kg/min). Cost of care and clinical outcomes (hospital admissions, length of hospital stay, NYHA functional class) were compared during the period of inotropic therapy (study period) and the immediate preceding period of equal duration (control period). In comparison to the control period, the study period (3.9+/-2.7 months) was associated with a 16% reduction in cost, amounting to a calculated savings of $5,700 per patient or $1,465 per patient per month. Concomitantly, a decrease in the number of hospital admissions from 2.7+/-2.6 to 1.3+/-1.3 (p=0.056) and length of hospital stay from 20.9+/-12.7 to 5.5+/-5.4 days (p=0.0004) was observed with improvement in NYHA functional class from 4.0+/-0.0 to 2.7+/-0.9 (phome i.v. inotropic therapy. Home i.v. inotropic therapy reduces hospital admissions, length of stay, and cost of care and improves functional class in patients with advanced (NYHA class IV) heart failure.

  5. Long-term outcome of patients with multiple [corrected] myeloma-related advanced renal failure following auto-SCT.

    Science.gov (United States)

    Glavey, S V; Gertz, M A; Dispenzieri, A; Kumar, S; Buadi, F; Lacy, M; Hayman, S R; Kapoor, P; Dingli, D; McCurdy, A; Hogan, W J; Gastineau, D A; Leung, N

    2013-11-01

    Renal failure commonly complicates multiple myeloma (MM) and is associated with reduced survival. It is not clear whether auto-SCT results in improved renal function or attainment of independence from dialysis in patients with advanced renal impairment due to MM. We conducted a retrospective cohort study of all patients who underwent auto-SCT for MM complicated by advanced renal failure at our institution over a 10-year period (2000-2010). We aimed to assess the association between auto-SCT and renal outcome in patients with serum creatinine (SCr) over 3 mg/dL, attributable to MM, including those who were dialysis dependent. Thirty patients (2.8% of all auto-SCT patients) met inclusion criteria. Fourteen of 15 patients who were dialysis dependent before auto-SCT remained dialysis dependent in the long term despite hematological response (HR). Of the remaining 15 patients with SCr >3 mg/dL, an improvement in glomerular filtration rate (GFR) from 15 to 19.4 mL/min/1.73 m(2) was noted post auto-SCT (P=0.035); however, neither HR post auto-SCT or pre-existing renal function were independently associated with renal outcome. Auto-SCT was not associated with independence from dialysis in patients with renal failure due to MM at our institution. Although auto-SCT was associated with an improvement in GFR in patients with SCr >3 mg/dL, this improvement was not related to HR.

  6. NRC concerns about steam generator tube U-bend failures

    International Nuclear Information System (INIS)

    Dillon, R.L.

    1981-01-01

    This paper concerns itself with genralized NRC regulatory policy regarding SGT failures and staff reports and opinions which may tend to influence the developing policy specific to U-bend failures. The most significant analysis at hand in predicting NRC policy on SGT U-bend failures is Marsh's Evaluation of Steam Generator Tube Rupture Events. Marsh sets out to describe and analyze the five steam generator tube ruptures that are known to NRC. All have occurred in the period 1975 to 1980

  7. Development of advanced fabrication technology for high-temperature gas-cooled reactor fuel. Reduction of coating failure fraction

    International Nuclear Information System (INIS)

    Minato, Kazuo; Kikuchi, Hironobu; Fukuda, Kousaku; Tobita, Tsutomu; Yoshimuta, Sigeharu; Suzuki, Nobuyuki; Tomimoto, Hiroshi; Nishimura, Kazuhisa; Oda, Takafumi

    1998-11-01

    The advanced fabrication technology for high-temperature gas-cooled reactor fuel has been developed to reduce the coating failure fraction of the fuel particles, which leads to an improvement of the reactor safety. The present report reviews the results of the relevant work. The mechanisms of the coating failure of the fuel particles during coating and compaction processes of the fuel fabrication were studied to determine a way to reduce the coating failure fraction of the fuel. The coating process was improved by optimizing the mode of the particle fluidization and by developing the process without unloading and loading of the particles at intermediate coating process. The compaction process was improved by optimizing the combination of the pressing temperature and the pressing speed of the overcoated particles. Through these modifications of the fabrication process, the quality of the fuel was improved outstandingly. (author)

  8. Recent Advances In Structural Vibration And Failure Mode Control In Mainland China: Theory, Experiments And Applications

    International Nuclear Information System (INIS)

    Li Hui; Ou Jinping

    2008-01-01

    A number of researchers have been focused on structural vibration control in the past three decades over the world and fruit achievements have been made. This paper introduces the recent advances in structural vibration control including passive, active and semiactive control in mainland China. Additionally, the co-author extends the structural vibration control to failure mode control. The research on the failure mode control is also involved in this paper. For passive control, this paper introduces full scale tests of buckling-restrained braces conducted to investigate the performance of the dampers and the second-editor of the Code of Seismic Design for Buildings. For active control, this paper introduces the HMD system for wind-induced vibration control of the Guangzhou TV tower. For semiactive control, the smart damping devices, algorithms for semi-active control, design methods and applications of semi-active control for structures are introduced in this paper. The failure mode control for bridges is also introduced

  9. Impact of few failure data on the opportunistic replacement policy for multi-component systems

    International Nuclear Information System (INIS)

    Laggoune, Radouane; Chateauneuf, Alaa; Aissani, Djamil

    2010-01-01

    In continuous operating units, the production loss is often very large during the system shut down. Their economic profitability is conditioned by the implementation of suitable maintenance policy that could increase the availability and reduce the operating costs. In this paper, an opportunistic replacement policy is proposed for multi-component series system in the context of data uncertainty, where the expected total cost per unit time is minimized under general lifetime distribution. When the system is down, either correctively or preventively, the opportunity to replace preventively non-failed components is considered. To deal with the problem of the small size of failure data samples, the Bootstrap technique is applied, in order to model the uncertainties in parameter estimates. The Weibull parameters are considered as random variables rather than just deterministic point estimates. A solution procedure based on Monte Carlo simulations with informative search method is proposed and applied to the optimization of preventive maintenance plan for a hydrogen compressor in an oil refinery.

  10. Entrepreneurship Policies: Principles, Problems and Opportunities

    OpenAIRE

    Karlsson, Charlie; Andersson, Martin

    2009-01-01

    In this paper, we discuss the current status of the literature on entrepreneurship policy. The purpose is to discuss and assess several fundamental questions pertaining to entrepreneurship policies, such as “What is the optimal rate of entrepreneurship?” and “What entrepreneurship policies to pursue to remedy market failures and to avoid policy failures?”. In the entrepreneurship policies literature several contributors make distinctions between five types of entrepreneurship policy: governme...

  11. Intermittent levosimendan infusions in advanced heart failure: favourable effects on left ventricular function, neurohormonal balance, and one-year survival.

    Science.gov (United States)

    Malfatto, Gabriella; Della Rosa, Francesco; Villani, Alessandra; Rella, Valeria; Branzi, Giovanna; Facchini, Mario; Parati, Gianfranco

    2012-11-01

    The role of repeated infusions of Levosimendan (LEVO) in patients with chronic advanced heart failure is still unclear. Thirty-three patients with chronic heart failure presenting clinical deterioration were randomized 2:1 to receive monthly infusions of LEVO (n = 22) or Furosemide (Controls, n = 11). At the first drug's administration, noninvasive hemodynamic evaluation was performed; before and after each infusion, we assessed NYHA class, systolic and diastolic function, functional mitral regurgitation, and brain natriuretic peptide (BNP) levels. Noninvasive hemodynamic in the LEVO group showed vasodilation and decrease in thoracic conductance (index of pulmonary congestion), whereas in Controls, only a reduced thoracic conductance was observed. In the LEVO group, systolic and diastolic function, ventricular volumes, severity of mitral regurgitation, and BNP levels improved over time from baseline and persisted 4 weeks after the last infusion (P < 0.01). In Controls, no change developed over time in cardiac function and BNP levels. In LEVO-treated patients, 1-year mortality tended to be lower than in those treated with Furosemide. In conclusion, serial LEVO infusions in advanced heart failure improved ventricular performance and favorably modulated neurohormonal activation. Multicenter randomized studies are warranted to test the effect of LEVO on long-term outcome.

  12. Left ventricular orientation and position in an advanced heart failure population

    Directory of Open Access Journals (Sweden)

    Antonia E. Curtin

    2017-06-01

    Full Text Available Introduction: Previous canine and in silico studies indicate that left ventricular (LV orientation and position have clinically significant effects on standard ECG elements, which are particularly relevant in an advanced heart failure (HF population. Our objectives were to investigate the real-world implications of these previous results by describing for the first time the range of LV orientations and positions in HF patients, identifying clinical predictors of orientation and position, and investigating how thoracic geometry may affect orientation and position. Materials and methods: Cardiac MRIs were used to measure LV orientation angles, LV position, chest dimensions, and the ratio of LV volume to thoracic area (LVTR. Multivariate regression analyses were used to identify significant predictors of orientation and position. Results: The mean frontal plane LV orientation angle was 31 ± 11° (range, 0°–47° and fell within the ranges used in previous studies of orientation effects. Orientation in the transverse plane, the effects of which have not been simulated, averaged 48 ± 10° (range, 21°–71°. The ranges of LV positions in the frontal and transverse planes (7.9 and 5.6 cm, respectively are similar to or greater than those used in silico. Orientation and position were weakly correlated with multiple significant predictors, and the relationship between HF progression and LV orientation and position could not be determined. Conclusion: Variation in LV orientation and position in advanced HF patients is large and cannot be readily predicted using the standard clinical variables or additional thoracic geometry measures used in this study. These findings may have significant clinical implications because of the possible effects of orientation and position on key ECG features. New tools and additional studies are needed before LV orientation or position data can be incorporated into clinical ECG interpretation. Keywords: Heart

  13. Image and Substance Failures in Regional Organisations: Causes, Consequences, Learning and Change?

    Directory of Open Access Journals (Sweden)

    Meng Hsuan Chou

    2016-08-01

    Full Text Available States often pool their sovereignty, capacity and resources to provide regionally specific public goods, such as security or trade rules, and regional organisations play important roles in international relations as institutions that attempt to secure peace and contribute to achieving other similar global policy goals. We observe failures occurring in these arrangements and activities in two areas: substance and image. To analytically account for this, we distinguish four modes of substance and image change and link these to specific types of failure and (lack of learning. To empirically ground and test our assumptions, we examine instances of image failure in ASEAN (political/security policy and substantive policy failure in EU labour migration policy. In so doing, this article contributes to several different fields of study and concepts that have hitherto rarely engaged with one another: analyses of policy failure from public policy, and regional integration concerns from area studies and international relations. We conclude with suggestions for ways forward to further analyse and understand failures at the international and supranational levels.

  14. Reduced Anxiety and Depression in Patients With Advanced Heart Failure After Left Ventricular Assist Device Implantation.

    Science.gov (United States)

    Yost, Gardner; Bhat, Geetha; Mahoney, Edward; Tatooles, Antone

    Despite the high prevalence of depression and anxiety in patients with advanced heart failure, the effects of left ventricular assist device (LVAD) implantation on these critically important aspects of mental health are not well understood. We sought to assess changes in depression and anxiety following LVAD implantation. The Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) were administered to 54 patients by a clinical psychologist at a mean of 12 days before LVAD implantation and 251 days after implantation. Patient demographics and clinical data were collected concurrently to psychologic testing. Changes in BDI-II, BAI, and clinical markers of heart failure were assessed using paired t-tests. A p Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  15. Tissue advanced glycation end products are associated with diastolic function and aerobic exercise capacity in diabetic heart failure patients

    NARCIS (Netherlands)

    Willemsen, Suzan; Hartog, Jasper W. L.; Hummel, Yoran M.; van Ruijven, Marieke H. I.; van der Horst, Iwan C. C.; van Veldhuisen, Dirk J.; Voors, Adriaan A.

    Aims Advanced glycation end products (AGEs) are increased in patients with diabetes and are associated with diastolic dysfunction through the formation of collagen crosslinks in the heart. The association among AGEs, diastolic function, and aerobic capacity in heart failure (HF) patients with and

  16. Fostering citizen deliberations on the social acceptability of renewable fuels policy: The case of advanced lignocellulosic biofuels in Canada

    International Nuclear Information System (INIS)

    Longstaff, Holly; Secko, David M.; Capurro, Gabriela; Hanney, Patricia; McIntyre, Terry

    2015-01-01

    It is widely recognized that a lack of social acceptance is likely to hinder the ability of governments to achieve policy targets concerning renewable energies. In this paper, we discuss the results of a pre- and post-test online survey that was conducted as part of the 2012 “Advanced Biofuels” deliberative democracy public engagement event in Montréal, Québec. The event sough to foster public learning and discussion in order to produce socially acceptable policy input for one type of renewable energy: advanced lignocellulosic biofuels. Survey results show that the majority of participants were strongly supportive of advanced lignocellulosic biofuel development in Canada after the deliberative event. By the end of the event, support also grew for current Canadian biofuel policies and many agreed that increasing biofuel production should be widely supported by the Canadian public. However, despite this support, about two thirds of participants revealed that they did not feel included in government decisions about biofuels. The gap between support after inclusive deliberation and expressed exclusion from Canadian government decisions points to the importance of fostering future citizen engagements in this area of renewable energy policy. - Highlights: • We analyze outputs from the 2012 “Advanced Biofuels” deliberative democracy event. • We focus on social acceptance levels of advanced lignocellulosic biofuels in Canada. • Participants became less supportive of using food crops after the deliberation. • The majority were also supportive of current federal policy after the event. • However, most did not feel included in government decisions about biofuels

  17. Advanced strategies for end-stage heart failure: combining regenerative approaches with LVAD, a new horizon?

    Directory of Open Access Journals (Sweden)

    Cheyenne eTseng

    2015-04-01

    Full Text Available Despite the improved treatment of cardiovascular diseases the population with end-stage heart failure is progressively growing. The scarcity of the gold standard therapy, heart transplantation, demands novel therapeutic approaches. For patients awaiting transplantation ventricular assist devices have been of great benefit on survival. To allow explantation of the assist device and obviate heart transplantation, sufficient and durable myocardial recovery is necessary. However, explant rates so far are low. Combining mechanical circulatory support with regenerative therapies such as cell(-based therapy and biomaterials might give rise to improved long-term results. Although synergistic effects are suggested with mechanical support and stem cell therapy, evidence in both preclinical and clinical setting is lacking. This review focuses on advanced and innovative strategies for the treatment of end-stage heart failure and furthermore appraises clinical experience with combined strategies.

  18. Generating news media interest in tobacco control; challenges in an advanced policy environment.

    Science.gov (United States)

    MacKenzie, Ross; Chapman, Simon

    2012-08-01

    To determine the efficacy of using media releases for tobacco control advocacy in Australia's advanced policy environment. Between February and August 2010, news releases that summarised either newly published but unpublicized research findings, or local developments in tobacco control, were sent to NSW media outlets. Reports arising from the releases were tracked using commercial services Media Monitors and Factiva, as well as Google and Google News. Other tobacco control related news items during the same period were also tracked and recorded. Twenty-one news releases generated 93 news items across all news media, with a quarter of these related to a story of porcine haemoglobin in cigarette filters. By comparison, 'live' policy issues (especially plain packaging and a significant tobacco tax increase) covered in this period attracted 1,033 news stories in the Australian media. Press releases describing recently published, but underpublicized research were issued in weeks where no major competing tobacco control news occurred. Results of this project indicate that in environments with advanced tobacco policy, media opportunities related to tobacco control advocacy are limited, as many objectives have been achieved. The media can still play a key advocacy role in such environments, and advocates need to be particularly vigilant for opportunities that do arise. The paper also highlights the increasingly important role of internet-based media, including opportunities presented by social media for tobacco control.

  19. Evaluation of Therapeutics for Advanced-Stage Heart Failure and Other Severely-Debilitating or Life-Threatening Diseases.

    Science.gov (United States)

    Prescott, J S; Andrews, P A; Baker, R W; Bogdanffy, M S; Fields, F O; Keller, D A; Lapadula, D M; Mahoney, N M; Paul, D E; Platz, S J; Reese, D M; Stoch, S A; DeGeorge, J J

    2017-08-01

    Severely-debilitating or life-threatening (SDLT) diseases include conditions in which life expectancy is short or quality of life is greatly diminished despite available therapies. As such, the medical context for SDLT diseases is comparable to advanced cancer and the benefit vs. risk assessment and development of SDLT disease therapeutics should be similar to that of advanced cancer therapeutics. A streamlined development approach would allow patients with SDLT conditions earlier access to therapeutics and increase the speed of progression through development. In addition, this will likely increase the SDLT disease therapeutic pipeline, directly benefiting patients and reducing the economic and societal burden of SDLT conditions. Using advanced-stage heart failure (HF) as an example that illustrates the concepts applicable to other SDLT indications, this article proposes a streamlined development paradigm for SDLT disease therapeutics and recommends development of aligned global regulatory guidance. © 2017 American Society for Clinical Pharmacology and Therapeutics.

  20. Parallel paths to improve heart failure outcomes

    DEFF Research Database (Denmark)

    Albert, Nancy M.

    2013-01-01

    -based, heart failure guidelines improves clinical outcomes. Thus, nurses and patients are on parallel paths related to setting the foundation for improved self-care adherence in advanced heart failure. Through research, we found that nurses were not adequately prepared as heart failure educators...... and that patients did not believe they were able to control heart failure. In 2 educational intervention studies that aimed to help patients understand that they could control fluid management and follow a strict daily fluid limit, patients had improved clinical outcomes. Thus, misperceptions about heart failure......Gaps and disparities in delivery of heart failure education by nurses and performance in accomplishing self-care behaviors by patients with advanced heart failure may be factors in clinical decompensation and unplanned consumption of health care. Is nurse-led education effectively delivered before...

  1. An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity.

    Science.gov (United States)

    Hankivsky, Olena; Grace, Daniel; Hunting, Gemma; Giesbrecht, Melissa; Fridkin, Alycia; Rudrum, Sarah; Ferlatte, Olivier; Clark, Natalie

    2014-12-10

    In the field of health, numerous frameworks have emerged that advance understandings of the differential impacts of health policies to produce inclusive and socially just health outcomes. In this paper, we present the development of an important contribution to these efforts - an Intersectionality-Based Policy Analysis (IBPA) Framework. Developed over the course of two years in consultation with key stakeholders and drawing on best and promising practices of other equity-informed approaches, this participatory and iterative IBPA Framework provides guidance and direction for researchers, civil society, public health professionals and policy actors seeking to address the challenges of health inequities across diverse populations. Importantly, we present the application of the IBPA Framework in seven priority health-related policy case studies. The analysis of each case study is focused on explaining how IBPA: 1) provides an innovative structure for critical policy analysis; 2) captures the different dimensions of policy contexts including history, politics, everyday lived experiences, diverse knowledges and intersecting social locations; and 3) generates transformative insights, knowledge, policy solutions and actions that cannot be gleaned from other equity-focused policy frameworks. The aim of this paper is to inspire a range of policy actors to recognize the potential of IBPA to foreground the complex contexts of health and social problems, and ultimately to transform how policy analysis is undertaken.

  2. Advanced Technological Education (ATE) Program: Building a Pipeline of Skilled Workers. Policy Brief

    Science.gov (United States)

    American Youth Policy Forum, 2010

    2010-01-01

    In the Fall of 2008, the American Youth Policy Forum hosted a series of three Capitol Hill forums showcasing the Advanced Technological Education (ATE) program supported by the National Science Foundation (NSF). The goal of these forums was to educate national policymakers about the importance of: (1) improving the science and math competencies of…

  3. Listened to, but not heard! The failure to represent the public in genetically modified food policies.

    Science.gov (United States)

    Lassen, Jesper

    2018-04-01

    'In the mid-1990s, a mismatch was addressed between European genetically modified food policy, which focused primarily on risks and economic prospects, and public anxieties, which also included other concerns, and there was a development in European food policy toward the inclusion of what were referred to as "ethical aspects." Using parliamentary debates in Denmark in 2002 and 2015 as a case, this article examines how three storylines of concern that were visible in public discourse at the time were represented by the decision makers in parliament. It shows that core public concerns raising fundamental questions about genetically modified foods, and in particular their perceived unnaturalness, were not considered in the parliamentary debates. It is suggested that the failure of the parliament to represent the public may undermine the legitimacy of politicians and lead to disillusionment with parliamentary government.

  4. On the economic analysis of problems in energy efficiency: Market barriers, market failures, and policy implications

    International Nuclear Information System (INIS)

    Sanstad, A.H.; Koomey, J.G.; Levine, M.D.

    1993-01-01

    In his recent paper in The Energy Journal, Ronald Sutherland argues that several so-called ''market barriers'' to energy efficiency frequently cited in the literature are not market failures in the conventional sense and are thus irrelevant for energy policy. We argue that Sutherland has inadequately analyzed the idea of market barrier and misrepresented the policy implications of microeconomics. We find that economic theory, correctly interpreted, does not provide for the categorical dismissal of market barriers. We explore important methodological issues underlying the debate over market barriers, and discuss the importance of reconciling the findings of non-economic social sciences with the economic analysis of energy demand and consumer decision-making. We also scrutinize Sutherland's attempt to apply finance theory to rationalize high implicit discount rates observed in energy-related choices, and find this use of finance theory to be inappropriate

  5. On the economic analysis of problems in energy efficiency: Market barriers, market failures, and policy implications

    Energy Technology Data Exchange (ETDEWEB)

    Sanstad, A.H.; Koomey, J.G.; Levine, M.D.

    1993-01-01

    In his recent paper in The Energy Journal, Ronald Sutherland argues that several so-called ``market barriers`` to energy efficiency frequently cited in the literature are not market failures in the conventional sense and are thus irrelevant for energy policy. We argue that Sutherland has inadequately analyzed the idea of market barrier and misrepresented the policy implications of microeconomics. We find that economic theory, correctly interpreted, does not provide for the categorical dismissal of market barriers. We explore important methodological issues underlying the debate over market barriers, and discuss the importance of reconciling the findings of non-economic social sciences with the economic analysis of energy demand and consumer decision-making. We also scrutinize Sutherland`s attempt to apply finance theory to rationalize high implicit discount rates observed in energy-related choices, and find this use of finance theory to be inappropriate.

  6. Science and Security Policy: The Case of Advanced Pathogens

    International Nuclear Information System (INIS)

    Harris, E. D.

    2007-01-01

    The revolution in biotechnology presents unprecedented opportunities and dangers for the health and well being of mankind. Today, one can plausibly imagine the eradication of many historic diseases. One can also envisage the creation of new diseases that would endanger a substantial proportion of the entire human species. As powerful applications for biotechnology research are identified, appropriate arrangements for managing their extraordinary consequences will inevitably become necessary. This presentation will explore recent efforts to balance science and security policy in the area of advanced biotechnology research. Key developments on the dual-use issue will be discussed, together with a variety of governance options aimed at mitigating the risk from such research. (author)

  7. Apatinib plus icotinib in treating advanced non-small cell lung cancer after icotinib treatment failure: a retrospective study

    Directory of Open Access Journals (Sweden)

    Xu J

    2017-10-01

    Full Text Available Jianping Xu, Xiaoyan Liu, Sheng Yang, Xiangru Zhang, Yuankai Shi Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, People’s Republic of China Background: Treatment failure frequently occurs in patients with epidermal growth factor receptor (EGFR-mutant non-small cell lung cancer (NSCLC who respond to EGFR tyrosine kinase inhibitors initially. This retrospective study tried to investigate the efficacy and safety of apatinib plus icotinib in patients with advanced NSCLC after icotinib treatment failure.Patients and methods: This study comprised 27 patients with advanced NSCLC who had progressed after icotinib monotherapy. Initially, patients received oral icotinib (125 mg, tid alone. When the disease progressed, they received icotinib plus apatinib (500 mg, qd, orally. Treatment was continued until disease progression, unacceptable toxicity or consent withdrawal.Results: Followed up to December 2016, the median time of combined therapy was 7.47 months, and eight of 27 patients were dead. The median overall survival was not reached, and median progression-free survival (PFS was 5.33 months (95% CI, 3.63–7.03 months. Moreover, the objective response rate (ORR was 11.1%, and the disease control rate (DCR was 81.5%. A total of 14 patients received combined therapy as the second-line treatment, and the ORR and DCR were 7.1% and 78.6%, respectively; 13 patients received drugs as the third- or later-line treatment, with an ORR and a DCR of 15.4% and 84.6%, respectively. In addition, 11 patients experienced icotinib monotherapy failure within 6 months with median PFS of 7.37 months, and 16 patients had progression after 6 months with median PFS of 2.60 months. The common drug-related toxic effects were hypertension (44.4% and fatigue (37.0%.Conclusion: Apatinib plus

  8. Pulmonary hypertension in patients with advanced heart failure is associated with increased levels of interleukin-6.

    Science.gov (United States)

    Dolenc, Jure; Šebeštjen, Miran; Vrtovec, Bojan; Koželj, Mirta; Haddad, François

    2014-08-01

    Inflammatory, endothelial and neurohormonal biomarkers are involved in heart failure (HF) and pulmonary hypertension (PH) pathogenesis. To study these biomarkers in PH due to advanced HF. Thirty adults with HF were included. Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hsCRP), endothelin-1 and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were measured in peripheral vein and pulmonary artery during right heart catheterisation. IL-6, TNF-α, hsCRP and NT-proBNP correlated with pulmonary pressures independent of ventricular function, HF etiology and vascular bed. IL-6 was independent predictor of systolic pulmonary artery pressure (sPAP). Inflammatory biomarkers correlate to PH severity. IL-6 predicts sPAP in advanced HF.

  9. Energy efficieny policy and carbon pricing

    Energy Technology Data Exchange (ETDEWEB)

    Ryan, Lisa; Moarif, Sara; Levina, Ellina; Baron, Richard

    2011-08-15

    The main message of this paper is that while carbon pricing is a prerequisite for least-cost carbon mitigation strategies, carbon pricing is not enough to overcome all the barriers to cost-effective energy efficiency actions. Energy efficiency policy should be designed carefully for each sector to ensure optimal outcomes for a combination of economic, social and climate change goals. This paper aims to examine the justification for specific energy efficiency policies in economies with carbon pricing in place. The paper begins with an inventory of existing market failures that attempt to explain the limited uptake of energy efficiency. These market failures are investigated to see which can be overcome by carbon pricing in two subsectors -- electricity use in residential appliances and heating energy use in buildings. This analysis finds that carbon pricing addresses energy efficiency market failures such as externalities and imperfect energy markets. However, several market and behavioural failures in the two subsectors are identified that appear not to be addressed by carbon pricing. These include: imperfect information; principal-agent problems; and behavioural failures. In this analysis, the policies that address these market failures are identified as complementary to carbon pricing and their level of interaction with carbon pricing policies is relatively positive. These policies should be implemented when they can improve energy efficiency effectively and efficiently (and achieve other national goals such as improving socio-economic efficiency).

  10. Energy Efficiency Policy and Carbon Pricing

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-07-01

    The main message of this paper is that while carbon pricing is a prerequisite for least-cost carbon mitigation strategies, carbon pricing is not enough to overcome all the barriers to cost-effective energy efficiency actions. Energy efficiency policy should be designed carefully for each sector to ensure optimal outcomes for a combination of economic, social and climate change goals. This paper aims to examine the justification for specific energy efficiency policies in economies with carbon pricing in place. The paper begins with an inventory of existing market failures that attempt to explain the limited uptake of energy efficiency. These market failures are investigated to see which can be overcome by carbon pricing in two subsectors -- electricity use in residential appliances and heating energy use in buildings. This analysis finds that carbon pricing addresses energy efficiency market failures such as externalities and imperfect energy markets. However, several market and behavioural failures in the two subsectors are identified that appear not to be addressed by carbon pricing. These include: imperfect information; principal-agent problems; and behavioural failures. In this analysis, the policies that address these market failures are identified as complementary to carbon pricing and their level of interaction with carbon pricing policies is relatively positive. These policies should be implemented when they can improve energy efficiency effectively and efficiently (and achieve other national goals such as improving socio-economic efficiency).

  11. Advancing team-based primary health care: a comparative analysis of policies in western Canada.

    Science.gov (United States)

    Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T

    2017-07-17

    We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

  12. On the economic analysis of problems in energy efficiency: Market barriers, market failures, and policy implications

    Energy Technology Data Exchange (ETDEWEB)

    Sanstad, A.H.; Koomey, J.G.; Levine, M.D.

    1993-01-01

    In his recent paper in The Energy Journal, Ronald Sutherland argues that several so-called market barriers'' to energy efficiency frequently cited in the literature are not market failures in the conventional sense and are thus irrelevant for energy policy. We argue that Sutherland has inadequately analyzed the idea of market barrier and misrepresented the policy implications of microeconomics. We find that economic theory, correctly interpreted, does not provide for the categorical dismissal of market barriers. We explore important methodological issues underlying the debate over market barriers, and discuss the importance of reconciling the findings of non-economic social sciences with the economic analysis of energy demand and consumer decision-making. We also scrutinize Sutherland's attempt to apply finance theory to rationalize high implicit discount rates observed in energy-related choices, and find this use of finance theory to be inappropriate.

  13. Readiness to participate in advance care planning: A qualitative study of renal failure patients, families and healthcare providers.

    Science.gov (United States)

    Hutchison, Lauren A; Raffin-Bouchal, Donna S; Syme, Charlotte A; Biondo, Patricia D; Simon, Jessica E

    2017-09-01

    Objectives Advance care planning is the process by which people reflect upon their wishes and values for healthcare, discuss their choices with family and friends and document their wishes. Readiness represents a key predictor of advance care planning participation; however, the evidence for addressing readiness is scarce within the renal failure context. Our objectives were to assess readiness for advance care planning and barriers and facilitators to advance care planning uptake in a renal context. Methods Twenty-five participants (nine patients, nine clinicians and seven family members) were recruited from the Southern Alberta Renal Program. Semi-structured interviews were recorded, transcribed and then analyzed using interpretive description. Results Readiness for advance care planning was driven by individual values perceived by a collaborative encounter between clinicians and patients/families. If advance care planning is not valued, then patients/families and clinicians are not ready to initiate the process. Patients and clinicians are delaying conversations until "illness burden necessitates," so there is little "advance" care planning, only care planning in-the-moment closer to the end of life. Discussion The value of advance care planning in collaboration with clinicians, patients and their surrogates needs reframing as an ongoing process early in the patient's illness trajectory, distinguished from end-of-life decision making.

  14. Relationship between advanced glycation end-products with the severity of chronic heart failure in 85 patients

    Directory of Open Access Journals (Sweden)

    Amir Farhang Zand Parsa

    2013-12-01

    Full Text Available Background: Advanced glycation end-products (AGEs came up with the recent researches regarding new biomarkers for the diagnosis of heart failure. AGEs are the end products of non-enzymatic glycation and oxidation of proteins, lipids and nucleotides during Maillard biochemical reaction. Although it has been known that AGEs have a role in the pathogenesis of chronic heart failure (CHF, information regarding its role and its pathogenetic mechanism is very limited. The aim of this study was to find any relationship between AGEs with the etiology and severity of chronic heart failure.Methods: This study is a prospective cross sectional study that enrolled 85 patients with chronic heart failure. Measurement of left ventricle ejection fraction (LVEF was done by echocardiography. Blood samples were collected for measuring AGEs just before or after echocardiography assessment (in the same session. Measurement of AGEs was done by the enzyme-linked immunosorbent assay (ELISA method. The relationship between AGEs with the severity of CHF and as well as the etiology of CHF were evaluated via SPSS-15.Results: Of 85 patients 48 (56.5% patients were male and 37 (43.5% were female; Mean±SD of their ages was 55.8±13.4 years old (ranges from 27 to 84 years. Correlation coefficient between LVEF and AGEs was 0.269 (P=0.013. Mean of AGEs in patients with and without ischemic etiology of their heart failure were 16.8±9.8µg/ml and 11.6±7.3 µg/ml, respectively. Although trend was in favor of ischemic heart failure, the difference between two groups was not statistically significant (P= 0.141.Conclusion: According to this study the rate of AGES could be helpful in the diagnosis and assessment of severity of CHF. Based on our findings, higher blood levels of AGEs in the ischemic CHF cases, also it could be concluded that in the future this marker may be used for etiologic differentiation of heart failure syndrome.

  15. Integrated environmental policy: A review of economic analysis.

    Science.gov (United States)

    Wiesmeth, Hans; Häckl, Dennis

    2017-04-01

    Holistic environmental policies, which emerged from a mere combination of technical activities in waste management some 40 years ago, constitute the most advanced level of environmental policies. These approaches to environmental policy, among them the policies in integrated waste management, attempt to guide economic agents to an environment-friendly behaviour. Nevertheless, current holistic policies in waste management, including policies on one-way drinks containers and waste electrical and electronic equipment, and implementations of extended producer responsibility with further applications to waste electrical and electronic equipment, reveal more or less severe deficiencies - despite some positive examples. This article relates these policy failures, which are not necessarily the result of an insufficient compliance with the regulations, to missing constitutive elements of what is going to be called an 'integrated environmental policy'. This article therefore investigates - mostly from a practical point of view - constitutive elements, which are necessary for a holistic policy to serve as a well-functioning allocation mechanism. As these constitutive elements result from a careful 'integration' of the environmental commodities into the economic allocation problems, we refer to these policies as 'integrated environmental policies'. The article also discusses and illustrates the main steps of designing such a policy - for waste electrical and electronic equipment and a (possible) ban of Glyphosat in agriculture. As these policies are dependent on economic and political stability with environmental awareness sufficiently developed, the article addresses mostly waste management policies in highly industrialised countries.

  16. LOW-LEVEL RADIOACTIVE WASTE: POLICY FAILURE, REGIONAL FAILURE. (R823191)

    Science.gov (United States)

    The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

  17. Policy Debate | Ecuador’s Yasuní-ITT Initiative : What Can We Learn from its Failure?

    Directory of Open Access Journals (Sweden)

    Pamela L. Martin

    2014-05-01

    Full Text Available Editor’s note: This paper is a contribution to the ‘Policy Debate’ section of International Development Policy. In this section, academics, policy-makers and practioners engage in a dialogue on global development challenges. Papers are copy-edited but not peer-reviewed. Instead, the initial thematic contribution is followed by critical comments and reactions from scholars and/or policy-makers.In her article ‘Pay to Preserve: The Global Politics of Ecuador’s Yasuní-ITT Proposal’, published in DevPol’s special issue on  Energy and Development in 2011, Pamela L. Martin, Associate Professor of Politics at the Coastal Carolina University in Conway, South Carolina, provided a favourable outlook on Ecuador’s innovative environmental governance mechanism. Accordingly, its unique potential lay in its objective of contributing towards sustainable development and social justice and in case of success, the author even predicted a possible replication in other developing countries. Despite its benefits, the initiative was abandoned in 2013. In this paper, Martin revisits the initiative and analyses the reasons for its failure, namely President Correa’s public pursuit of a Plan B, entering into negotiations with oil firms interested to explore the ITT reserves. Moreover, the initiative was in stark competition with the national REDD+ programme, the mainstream policy approach to reduce emissions from deforestation and forest degradation against payments, which is being negotiated under the United Nations Framework Convention on Climate Change (UNFCCC.Pamela L. Martin’s article is followed by a response by Dr. Imme Scholz, Deputy Director of the German Development Institute/Deutsches Institut für Entwicklungspolitik (DIE. She examines why Germany, as the largest European donor, withdrew its support for the Yasuní-ITT Initiative.Readers who are intetested are invited to contribute to this policy debate on our blog .Download the whole

  18. Allogeneic mesenchymal precursor cells (MPCs): an innovative approach to treating advanced heart failure.

    Science.gov (United States)

    Westerdahl, Daniel E; Chang, David H; Hamilton, Michele A; Nakamura, Mamoo; Henry, Timothy D

    2016-09-01

    Over 37 million people worldwide are living with Heart Failure (HF). Advancements in medical therapy have improved mortality primarily by slowing the progression of left ventricular dysfunction and debilitating symptoms. Ultimately, heart transplantation, durable mechanical circulatory support (MCS), or palliative care are the only options for patients with end-stage HF. Regenerative therapies offer an innovative approach, focused on reversing myocardial dysfunction and restoring healthy myocardial tissue. Initial clinical trials using autologous (self-donated) bone marrow mononuclear cells (BMMCs) demonstrated excellent safety, but only modest efficacy. Challenges with autologous stem cells include reduced quality and efficacy with increased patient age. The use of allogeneic mesenchymal precursor cells (MPCs) offers an "off the shelf" therapy, with consistent potency and less variability than autologous cells. Preclinical and initial clinical trials with allogeneic MPCs have been encouraging, providing the support for a large ongoing Phase III trial-DREAM-HF. We provide a comprehensive review of preclinical and clinical data supporting MPCs as a therapeutic option for HF patients. The current data suggest allogeneic MPCs are a promising therapy for HF patients. The results of DREAM-HF will determine whether allogeneic MPCs can decrease major adverse clinical events (MACE) in advanced HF patients.

  19. [Advanced organ failure in the elderly. Some issues from a geriatrics, palliative medicine and bioethics perspectives].

    Science.gov (United States)

    Alonso-Renedo, Francisco Javier; González-Ercilla, Leire; Iráizoz-Apezteguía, Itziar

    2014-01-01

    To analyze the literature as regards the knowledge, skills and attitudes that these disciplines can provide in improving technical, ethical and human quality health care in the elderly with advanced organ failure, multimorbidity, frailty and progressive dementia. A comprehensive review focused on available references on the interrelationship between geriatric medicine and palliative medicine, education in bioethics, prognostic tools, functional status, and the humanization of health care. Advance care planning, comprehensive geriatric assessment, the study of the values of the patient and their introduction in decision-making process, as well as the need to promote moral, care, and healthcare organizational ethics, are essential elements to achieve this objective. Practitioners and healthcare organizations should seek excellence as a moral requirement. To achieve this, there is a priority to acquire virtues of care and fundamental concepts of geriatric and palliative medicine, assessing functional status, advance care planning and patient/family needs as essential issues to protect, care for and promote them in all care settings. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

  20. Advanced korean industrial safety and health policy with risk assessment.

    Science.gov (United States)

    Kwon, Hyuckmyun; Cho, Jae Hyun; Moon, Il; Choi, Jaewook; Park, Dooyong; Lee, Youngsoon

    2010-09-01

    This article describes a systematic roadmap master plan for advanced industrial safety and health policy in Korea, with an emphasis on. Since Korean industries had first emergence of industrial safety and health policy in 1953, enormous efforts have been made on upgrading the relevant laws in order to reflect real situation of industrial work environment in accordance with rapid changes of Korean and global business over three decades. Nevertheless, current policy has major defects; too much techniques-based articles, diverged contents in less organization, combined enforcement and punishments and finally enforcing regulations full of commands and control. These deficiencies have make it difficult to accommodate changes of social, industrial and employment environment in customized fashion. The approach to the solution must be generic at the level of paradigm-shift rather than local modifications and enhancement. The basic idea is to establish a new system integrated with a risk assessment scheme, which encourages employers to apply to their work environment under comprehensive responsibility. The risk assessment scheme is designed to enable to inspect employers' compliances afterwards. A project comprises four yearly phases based on applying zones; initially designating and operating a specified risk zone, gradually expanding the special zones during a period of 3 years (2010-2012) and the final zone expanded to entire nation. In each phase, the intermediate version of the system is updated through a process of precise and unbiased validation in terms of its operability, feasibility and sustainability with building relevant infrastructures as needed.

  1. The failure of earthquake failure models

    Science.gov (United States)

    Gomberg, J.

    2001-01-01

    In this study I show that simple heuristic models and numerical calculations suggest that an entire class of commonly invoked models of earthquake failure processes cannot explain triggering of seismicity by transient or "dynamic" stress changes, such as stress changes associated with passing seismic waves. The models of this class have the common feature that the physical property characterizing failure increases at an accelerating rate when a fault is loaded (stressed) at a constant rate. Examples include models that invoke rate state friction or subcritical crack growth, in which the properties characterizing failure are slip or crack length, respectively. Failure occurs when the rate at which these grow accelerates to values exceeding some critical threshold. These accelerating failure models do not predict the finite durations of dynamically triggered earthquake sequences (e.g., at aftershock or remote distances). Some of the failure models belonging to this class have been used to explain static stress triggering of aftershocks. This may imply that the physical processes underlying dynamic triggering differs or that currently applied models of static triggering require modification. If the former is the case, we might appeal to physical mechanisms relying on oscillatory deformations such as compaction of saturated fault gouge leading to pore pressure increase, or cyclic fatigue. However, if dynamic and static triggering mechanisms differ, one still needs to ask why static triggering models that neglect these dynamic mechanisms appear to explain many observations. If the static and dynamic triggering mechanisms are the same, perhaps assumptions about accelerating failure and/or that triggering advances the failure times of a population of inevitable earthquakes are incorrect.

  2. State Department Advanced Medium Range Air-to-Air Missile (AMRAAM) Policy: A Nod to Non-Proliferation

    National Research Council Canada - National Science Library

    Cabot, Jr, Nelson

    2003-01-01

    ...) in regions where a like capability has yet to be introduced. The policy was conceived as an attempt to foster regional stability in regions where the proliferation of advanced weaponry may lead to the start of a local arms race...

  3. Producer-retailer integrated EMQ system with machine breakdown, rework failures, and a discontinuous inventory issuing policy.

    Science.gov (United States)

    Chiu, Singa Wang; Chen, Shin-Wei; Chiu, Yuan-Shyi Peter; Li, Ting-Wei

    2016-01-01

    This study develops two extended economic manufacturing quantity (EMQ)-based models with a discontinuous product issuing policy, random machine breakdown, and rework failures. Various real conditions in production processes, end-product delivery, and intra-supply chains such as a producer-retailer integrated scheme are examined. The first model incorporates a discontinuous multi-delivery policy into a prior work (Chiu et al. in Proc Inst Mech Eng B J Eng 223:183-194, 2009) in lieu of their continuous policy. Such an enhanced model can address situations in supply chain environments, where finished products are transported to outside retail stores (or customers). The second model further combines retailer's stock holding costs into the first model. This extended EMQ model is applicable in situations in present-day manufacturing firms where finished products are distributed to company's own retail stores (or regional sales offices) and stocked there for sale. Two aforementioned extended EMQ models are investigated, respectively. Mathematical modeling along with iterative algorithms are employed to derive the optimal production run times that minimize the expected total system costs, including the costs incurred in production units, transportation, and retail stores, for these integrated EMQ systems. Numerical examples are provided to demonstrate the practical application of the research results.

  4. Globalisation, rural restructuring and health service delivery in Australia: policy failure and the role of social work?

    Science.gov (United States)

    Alston, Margaret

    2007-05-01

    The impacts of globalisation and rural restructuring on health service delivery in rural Australia have been significant. In the present paper, it is argued that declining health service access represents a failure of policy. Rural communities across the world are in a state of flux, and Australia is no different: rural communities are ageing at faster rates than urban communities and young people are out-migrating in large numbers. During the past 5 years, rural Australia has also experienced a severe and widespread drought that has exacerbated rural poverty, and impacted on the health and well-being of rural Australians. Australian governments have responded to globalising forces by introducing neoliberal policy initiatives favouring market solutions and championing the need for self-reliance among citizens. The result for rural Australia has been a withdrawal of services at a time of increased need. This paper addresses the social work response to these changes.

  5. Experimental Assessment of Tensile Failure Characteristic for Advanced Composite Laminates

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myoung Keon [Agency for Defense Development, Daejeon (Korea, Republic of); Lee, Jeong Won; Yoon, Dong Hyun; Kim, Jae Hoon [Chungnam Nat’l Univ., Daejeon (Korea, Republic of)

    2017-10-15

    In recent years, major airplane manufacturers have been using the laminate failure theory to estimate the strain of composite structures for airplanes. The laminate failure theory uses the failure strain of the laminate to analyze composite structures. This paper describes a procedure for the experimental assessment of laminate tensile failure characteristics. Regression analysis was used as the experimental assessment method. The regression analysis was performed with the response variable being the laminate failure strain and with the regressor variables being two-ply orientation (0° and ±45°) variables. The composite material in this study is a carbon/epoxy unidirectional (UD) tape that was cured as a pre-preg at 177°C(350°F). A total of 149 tension tests were conducted on specimens from 14 distinct laminates that were laid up at standard angle layers (0°, 45°, -45°, and 90°). The ASTM-D-3039 standard was used as the test method.

  6. Experimental Assessment of Tensile Failure Characteristic for Advanced Composite Laminates

    International Nuclear Information System (INIS)

    Lee, Myoung Keon; Lee, Jeong Won; Yoon, Dong Hyun; Kim, Jae Hoon

    2017-01-01

    In recent years, major airplane manufacturers have been using the laminate failure theory to estimate the strain of composite structures for airplanes. The laminate failure theory uses the failure strain of the laminate to analyze composite structures. This paper describes a procedure for the experimental assessment of laminate tensile failure characteristics. Regression analysis was used as the experimental assessment method. The regression analysis was performed with the response variable being the laminate failure strain and with the regressor variables being two-ply orientation (0° and ±45°) variables. The composite material in this study is a carbon/epoxy unidirectional (UD) tape that was cured as a pre-preg at 177°C(350°F). A total of 149 tension tests were conducted on specimens from 14 distinct laminates that were laid up at standard angle layers (0°, 45°, -45°, and 90°). The ASTM-D-3039 standard was used as the test method.

  7. Myostatin signaling is up-regulated in female patients with advanced heart failure.

    Science.gov (United States)

    Ishida, Junichi; Konishi, Masaaki; Saitoh, Masakazu; Anker, Markus; Anker, Stefan D; Springer, Jochen

    2017-07-01

    Myostatin, a negative regulator of skeletal muscle mass, is up-regulated in the myocardium of heart failure (HF) and increased myostatin is associated with weight loss in animal models with HF. Although there are disparities in pathophysiology and epidemiology between male and female patients with HF, it remains unclear whether there is gender difference in myostatin expression and whether it is associated with weight loss in HF patients. Heart tissue samples were collected from patients with advanced heart failure (n=31, female n=5) as well as healthy control donors (n=14, female n=6). Expression levels of myostatin and its related proteins in the heart were evaluated by western blotting analysis. Body mass index was significantly lower in female HF patients than in male counterparts (20.0±4.2 in female vs 25.2±3.8 in male, p=0.04). In female HF patients, both mature myostatin and pSmad2 were significantly up-regulated by 1.9 fold (p=0.05) and 2.5 fold (pmyostatin was not. There was no significant difference in protein expression related to myostatin signaling between male and female patients. In this study, myostatin and pSmad2 were significantly up-regulated in the failing heart of female patients, but not male patients, and female patients displayed lower body mass index. Enhanced myostatin signaling in female failing heart may causally contribute to pathogenesis of HF and cardiac cachexia. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Dispersed Trading and the Prevention of Market Failure

    DEFF Research Database (Denmark)

    Porter, David C.; Tanggaard, Carsten; G. Weaver, Daniel

    With augmented demands on power grids resulting in longer and larger blackouts combined with heightened concerns of terrorist attacks, trading institutions and policy makers have widened their search for systems that avoid market failure during these disturbing events. We provide insight into thi......With augmented demands on power grids resulting in longer and larger blackouts combined with heightened concerns of terrorist attacks, trading institutions and policy makers have widened their search for systems that avoid market failure during these disturbing events. We provide insight...... combined with widely dispersed trading locations may be a viable means of protection against market failure during massive power disruptions or terrorist attacks....

  9. An empirical study on the human error recovery failure probability when using soft controls in NPP advanced MCRs

    International Nuclear Information System (INIS)

    Jang, Inseok; Kim, Ar Ryum; Jung, Wondea; Seong, Poong Hyun

    2014-01-01

    Highlights: • Many researchers have tried to understand human recovery process or step. • Modeling human recovery process is not sufficient to be applied to HRA. • The operation environment of MCRs in NPPs has changed by adopting new HSIs. • Recovery failure probability in a soft control operation environment is investigated. • Recovery failure probability here would be important evidence for expert judgment. - Abstract: It is well known that probabilistic safety assessments (PSAs) today consider not just hardware failures and environmental events that can impact upon risk, but also human error contributions. Consequently, the focus on reliability and performance management has been on the prevention of human errors and failures rather than the recovery of human errors. However, the recovery of human errors is as important as the prevention of human errors and failures for the safe operation of nuclear power plants (NPPs). For this reason, many researchers have tried to find a human recovery process or step. However, modeling the human recovery process is not sufficient enough to be applied to human reliability analysis (HRA), which requires human error and recovery probabilities. In this study, therefore, human error recovery failure probabilities based on predefined human error modes were investigated by conducting experiments in the operation mockup of advanced/digital main control rooms (MCRs) in NPPs. To this end, 48 subjects majoring in nuclear engineering participated in the experiments. In the experiments, using the developed accident scenario based on tasks from the standard post trip action (SPTA), the steam generator tube rupture (SGTR), and predominant soft control tasks, which are derived from the loss of coolant accident (LOCA) and the excess steam demand event (ESDE), all error detection and recovery data based on human error modes were checked with the performance sheet and the statistical analysis of error recovery/detection was then

  10. The Significance Mild Renal Dysfunction in Chronic Heart Failure ...

    African Journals Online (AJOL)

    BACKGROUND: Heart failure is a major public health concern. Prediction models in heart failure have employed echocardiography and other advanced laboratory parameters in predicting the risk of mortality.However, most of the patients in the resource poor economies still do not have easy access to these advanced ...

  11. The institutionalization of gender equality policies at the Spanish university. Advances and challenges

    Directory of Open Access Journals (Sweden)

    Inma Pastor Gosalbez

    2016-12-01

    Full Text Available The path to eliminating gender gaps moves between advances and promises. Its pace is determined by the combination of policies, legislation and social changes. Despite the measures taken, gender inequality persists in scientific, technological and academic fields. Equality Plans, which must be implemented at Spanish universities since the adoption of the Organic Law 3/2007 of 22 March for the effective equality of women and men, constitute an important, but not sufficient, step to achieve equality in this area. A key factor can be the structures and networks for the implementation of equality policies (intra- and interuniversity ones, as well as those with other agencies and institutions, which are not sufficiently developed at present. This article describes the process of institutionalization of equality policies at Spanish universities and presents an analysis of the legislation applicable to university level. Furthermore, data about equality units and their characteristics are shown. The article concludes with a reflection upon the elements that can increase the impact of university equality structures as well as the remaining challenges.

  12. Impact of advanced fuel cycle options on waste management policies

    International Nuclear Information System (INIS)

    Gordelier, Stan; Cavedon, Jean-Marc

    2006-01-01

    OECD/NEA has performed a study on the impact of advanced fuel cycle options on waste management policies with 33 experts from 12 member countries, 1 non-member country and 2 international organizations. The study extends a series of previous ones on partitioning and transmutation (P and T) issues, focusing on the performance assessments for repositories of high-level waste (HLW) arising from advanced fuel cycles. This study covers a broader spectrum than previous studies, from present industrial practice to fully closed cycles via partially closed cycles (in terms of transuranic elements); 9 fuel cycle schemes and 4 variants. Elements of fuel cycles are considered primarily as sources of waste, the internal mass flows of each scheme being kept for the sake of mass conservation. The compositions, activities and heat loads of all waste flows are also tracked. Their impact is finally assessed on the waste repository concepts. The study result confirms the findings from the previous NEA studies on P and T on maximal reduction of the waste source term and maximal use of uranium resources. In advanced fuel cycle schemes the activity of the waste is reduced by burning first plutonium and then minor actinides and also the uranium consumption is reduced, as the fraction of fast reactors in the park is increased to 100%. The result of the repository performance assessments, analysing the effect of different HLW isotopic composition on repository performance and on repository capacity, shows that the maximum dose released to biosphere at any time in normal conditions remains, for all schemes and for all the repository concepts examined, well below accepted radiation protection thresholds. The major impact is on the detailed concept of the repositories, through heat load and waste volume. Advanced fuel cycles could allow a repository to cover waste produced from 5 to 20 times more electricity generation than PWR once-through cycle. Given the flexibility of the advanced fuel

  13. Advanced Korean Industrial Safety and Health Policy with Risk Assessment

    Directory of Open Access Journals (Sweden)

    Hyuckmyun Kwon

    2010-09-01

    Full Text Available This article describes a systematic roadmap master plan for advanced industrial safety and health policy in Korea, with an emphasis on. Since Korean industries had first emergence of industrial safety and health policy in 1953, enormous efforts have been made on upgrading the relevant laws in order to reflect real situation of industrial work environment in accordance with rapid changes of Korean and global business over three decades. Nevertheless, current policy has major defects; too much techniques-based articles, diverged contents in less organization, combined enforcement and punishments and finally enforcing regulations full of commands and control. These deficiencies have make it difficult to accommodate changes of social, industrial and employment environment in customized fashion. The approach to the solution must be generic at the level of paradigm- shift rather than local modifications and enhancement. The basic idea is to establish a new system integrated with a risk assessment scheme, which encourages employers to apply to their work environment under comprehensive responsibility. The risk assessment scheme is designed to enable to inspect employers’ compliances afterwards. A project comprises four yearly phases based on applying zones; initially designating and operating a specified risk zone, gradually expanding the special zones during a period of 3 years (2010-2012 and the final zone expanded to entire nation. In each phase, the intermediate version of the system is updated through a process of precise and unbiased validation in terms of its operability, feasibility and sustainability with building relevant infrastructures as needed.

  14. Outcomes of Ahmed glaucoma valve implantation in advanced primary congenital glaucoma with previous surgical failure

    OpenAIRE

    Huang, Jingjing; Lin, Jialiu; Wu, Ziqiang; Xu, Hongzhi; Zuo, Chengguo; Ge, Jian

    2015-01-01

    Jingjing Huang,1 Jialiu Lin,1 Ziqiang Wu,2 Hongzhi Xu,3 Chengguo Zuo,1 Jian Ge1 1State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Center for Advanced Eye Care, Carson City, NV, USA; 3Institute of Child Health Policy, University of Florida, Gainesville, FL, USA Purpose: The purpose of this study was to evaluate the intermediate surgical results of Ahmed glaucoma valve...

  15. Treatment of chronic heart failure with aldosterone-blocking agents

    NARCIS (Netherlands)

    van Veldhuisen, Dirk J.; Swedberg, Karl

    Three large randomized trials in advanced heart failure (RALES), in heart failure after myocardial infarction (EPHESUS), and most recently mild heart failure (EMPHASIS-HF) have firmly established the place of aldosterone-blocking agents in patients with heart failure. In this paper we will shortly

  16. Meteorological Satellites (METSAT) and Earth Observing System (EOS) Advanced Microwave Sounding Unit-A (AMSU-A) Failure Modes and Effects Analysis (FMEA) and Critical Items List (CIL)

    Science.gov (United States)

    1996-01-01

    This Failure Modes and Effects Analysis (FMEA) is for the Advanced Microwave Sounding Unit-A (AMSU-A) instruments that are being designed and manufactured for the Meteorological Satellites Project (METSAT) and the Earth Observing System (EOS) integrated programs. The FMEA analyzes the design of the METSAT and EOS instruments as they currently exist. This FMEA is intended to identify METSAT and EOS failure modes and their effect on spacecraft-instrument and instrument-component interfaces. The prime objective of this FMEA is to identify potential catastrophic and critical failures so that susceptibility to the failures and their effects can be eliminated from the METSAT/EOS instruments.

  17. An integrated energy policy for Korea

    International Nuclear Information System (INIS)

    Kim, Tai-Yoo; Kim, Seung-Rae

    1993-01-01

    Economic theory defines a market failure when competitive markets cannot reach an equilibrium maximizing social welfare. One of its most typical examples has proved to be the energy market. Exhaustible energy resources provide the limits to economic growth, at least in the short term. Thus an energy policy for energy importing countries like Korea has been focused on minimizing the negative influences of external energy price shocks to the domestic economy. This study suggests one of the possible directions for an integrated energy policy which seeks to present a flow of policy rules which lead government policy to attain equilibrium, maximizing the national economic benefits by offsetting the market failure

  18. Refeeding syndrome in a patient with advanced Kidney failure due to Nephronophthisis

    Directory of Open Access Journals (Sweden)

    Kamel El-Reshaid

    2013-01-01

    Full Text Available Refeeding syndrome (RS is a serious and potentially fatal disorder. It is caused by a shift of fluids, sodium, potassium, magnesium and phosphorus as well changes in the metabolism of glucose, protein, fat and vitamins following the refeeding of malnourished patients, whether enterally or parenterally. RS has rarely been reported in patients with advanced kidney disease probably due to the pre-existing hyperphosphatemia, hypermagnesemia and hyperkalemia in these patients. In the following report, we present a patient with nephronophthisis type 1 deletion syndrome in whom her main previous nutrition was limited to simply rehydration to avoid renal replacement therapy. On presentation, she was cachectic and dehydrated with advanced kidney failure. She was treated with medical nephrectomy using non-steroidal anti-inflammatory drugs and then placed on maintenance hemodialysis. Percutaneous endoscopic gastrostomy was used for her initial feeding. Care was exercised during her early refeeding with regard to correction of fluids and essential electrolytes, viz. potassium, phosphorus and magnesium, as well as multivitamins to avoid the cardiovascular and neurological complications of RS. However, the changes in the gut, pancreas and liver as well as her hyperlipidemia were a clear obstacle. Fortunately, the ileus and pancreatitis she developed on refeeding improved dramatically with a decrease of the feeding dose to half; however, the liver abnormalities and hyperlipidemia were severe and slow to recover. These improved after addition of ursodeoxycholic acid and permitted successful increase of the dose of feeding subsequently.

  19. Refeeding syndrome in a patient with advanced kidney failure due to nephronophthisis.

    Science.gov (United States)

    El-Reshaid, Kamel

    2013-11-01

    Refeeding syndrome (RS) is a serious and potentially fatal disorder. It is caused by a shift of fluids, sodium, potassium, magnesium and phosphorus as well changes in the metabolism of glucose, protein, fat and vitamins following the refeeding of malnourished patients, whether enterally or parenterally. RS has rarely been reported in patients with advanced kidney disease probably due to the pre-existing hyperphosphatemia, hypermagnesemia and hyperkalemia in these patients. In the following report, we present a patient with nephronophthisis type 1 deletion syndrome in whom her main previous nutrition was limited to simply rehydration to avoid renal replacement therapy. On presentation, she was cachectic and dehydrated with advanced kidney failure. She was treated with medical nephrectomy using non-steroidal anti-inflammatory drugs and then placed on maintenance hemodialysis. Percutaneous endoscopic gastrostomy was used for her initial feeding. Care was exercised during her early refeeding with regard to correction of fluids and essential electrolytes, viz. potassium, phosphorus and magnesium, as well as multivitamins to avoid the cardiovascular and neurological complications of RS. However, the changes in the gut, pancreas and liver as well as her hyperlipidemia were a clear obstacle. Fortunately, the ileus and pancreatitis she developed on refeeding improved dramatically with a decrease of the feeding dose to half; however, the liver abnormalities and hyperlipidemia were severe and slow to recover. These improved after addition of ursodeoxycholic acid and permitted successful increase of the dose of feeding subsequently.

  20. Climate policy: Risk-averse governments

    Science.gov (United States)

    Harris, Paul G.

    2014-04-01

    Relative to the scale of the problem, climate policies worldwide have failed. Now research explains why policy innovations are often inadequate, routinely reflecting the aversion of policymakers to the risk of failure.

  1. NATO Advanced Research Institute on the Application of Systems Science to Energy Policy Planning

    CERN Document Server

    Cherniavsky, E; Laughton, M; Ruff, L

    1981-01-01

    The Advanced Research Institute (ARI) on "The Application of Systems Science to Energy Policy Planning" was held under the auspices of the NATO Special Programme Panel on Systems Science in collaboration with the National Center for Analysis of Energy Sys­ tems, Brookhaven National Laboratory, USA, as a part of the NATO Science Committee's continuous effort to promote the advancement of science through international cooperation. Advanced Research Institutes are sponsored by the NATO Science Committee for the purposes of bringing together senior scientists to seek consensus on an assessment of the present state of knowl­ edge on a specific topic and to make recommendations for future research directions. Meetings are structured to encourage inten­ sive group discussion. Invitees are carefully selected so that the group as a whole will contain the experience and expertise neces­ sary to make the conclusions valid and significant. A final report is published presenting the various viewpoints and conclusions....

  2. Advancing environmental and policy change through active living collaboratives: compositional and stakeholder engagement correlates of group effectiveness.

    Science.gov (United States)

    Litt, Jill; Reed, Hannah; Zieff, Susan G; Tabak, Rachel G; Eyler, Amy A; Tompkins, Nancy Oʼhara; Lyn, Rodney; Gustat, Jeanette; Goins, Karen Valentine; Bornstein, Daniel

    2013-01-01

    This study aims to evaluate compositional factors, including collaborative age and size, and community, policy, and political engagement activities that may influence collaboratives' effectiveness in advancing environmental improvements and policies for active living. Structured interviews were conducted with collaboratives' coordinators. Survey items included organizational composition, community, policy, and political engagement activities and reported environmental improvements and policy change. Descriptive statistics and multivariate models were used to investigate these relationships. Environmental improvement and policy change scores reflecting level of collaborative effectiveness across 8 strategy areas (eg, parks and recreation, transit, streetscaping, and land redevelopment). Fifty-nine collaborative groups participated in the interview, representing 22 states. Groups have made progress in identifying areas for environmental improvements and in many instances have received funding to support these changes. Results from multivariate models indicate that engagement in media communication and advocacy was statistically correlated with higher levels of environmental improvement, after adjusting for age of group and area poverty levels (P engagement activities may represent important levers for achieving structural and policy changes to the built environment.

  3. Strategies for optical transport network recovery under epidemic network failures

    DEFF Research Database (Denmark)

    Ruepp, Sarah Renée; Fagertun, Anna Manolova; Kosteas, Vasileios

    2015-01-01

    The current trend in deploying automatic control plane solutions for increased flexibility in the optical transport layer leads to numerous advantages for both the operators and the customers, but also pose challenges related to the stability of the network and its ability to operate in a robust...... manner under different failure scenarios. This work evaluates two rerouting strategies and proposes four policies for failure handling in a connection-oriented optical transport network, under generalized multiprotocol label switching control plane. The performance of the strategies and the policies......, and that there exist a clear trade-off between policy performance and network resource consumption, which must be addressed by network operators for improved robustness of their transport infrastructures. Applying proactive methods for avoiding areas where epidemic failures spread results in 50% less connections...

  4. Federal funding for syringe exchange in the US: Explaining a long-term policy failure.

    Science.gov (United States)

    Showalter, David

    2018-05-01

    The United States prohibited federal funding for syringe exchange programs for people who inject drugs nearly continuously from 1988 to 2015, despite growing scientific evidence, diminishing AIDS-related controversy, and tens of thousands of deaths from injection-related AIDS. This study investigates the political and institutional bases of this long-term failure to support lifesaving public policy. This study draws on national, regional, and local media coverage, archival sources, and semi-structured, in-depth interviews with 6 long-time syringe exchange researchers and activists from California. I use case-oriented process tracing methods to explain the persistence and reform of the federal funding ban. Though previous studies focus on the symbolic clash between conservative morality and empirical science, I find that changing demographic and regional inequalities in the effects of the AIDS epidemic and dynamics produced by the federal structure of US government were more important factors in the creation and persistence of the funding ban. The persistence and eventual repeal of the ban on federal funding for syringe exchange was a product of the changing demographic, geographic, and political effects of the AIDS epidemic within the federal structure of US government, rather than a consequence of intractable morality politics. These contextual dynamics continue to shape AIDS and public health policy at all levels of government. Copyright © 2018. Published by Elsevier B.V.

  5. Mathematical modeling of a multi-product EMQ model with an enhanced end items issuing policy and failures in rework.

    Science.gov (United States)

    Chiu, Yuan-Shyi Peter; Sung, Peng-Cheng; Chiu, Singa Wang; Chou, Chung-Li

    2015-01-01

    This study uses mathematical modeling to examine a multi-product economic manufacturing quantity (EMQ) model with an enhanced end items issuing policy and rework failures. We assume that a multi-product EMQ model randomly generates nonconforming items. All of the defective are reworked, but a certain portion fails and becomes scraps. When rework process ends and the entire lot of each product is quality assured, a cost reduction n + 1 end items issuing policy is used to transport finished items of each product. As a result, a closed-form optimal production cycle time is obtained. A numerical example demonstrates the practical usage of our result and confirms a significant savings in stock holding and overall production costs as compared to that of a prior work (Chiu et al. in J Sci Ind Res India, 72:435-440 2013) in the literature.

  6. A preventive maintenance model with a two-level inspection policy based on a three-stage failure process

    International Nuclear Information System (INIS)

    Wang, Wenbin; Zhao, Fei; Peng, Rui

    2014-01-01

    Inspection is always an important preventive maintenance (PM) activity and can have different depths and cover all or part of plant systems. This paper introduces a two-level inspection policy model for a single component plant system based on a three-stage failure process. Such a failure process divides the system′s life into three stages: good, minor defective and severe defective stages. The first level of inspection, the minor inspection, can only identify the minor defective stage with a certain probability, but can always reveal the severe defective stage. The major inspection can however identify both defective stages perfectly. Once the system is found to be in the minor defective stage, a shortened inspection interval is adopted. If however the system is found to be in the severe defective stage, we may delay the maintenance action if the time to the next planned PM window is less than a threshold level, but otherwise, replace immediately. This corresponds to the well adopted maintenance policy in practice such as periodic inspections with planned PMs. A numerical example is presented to demonstrate the proposed model by comparing with other models. - Highlights: • The system′s deterioration goes through a three-stage process, namely, normal, minor defective and severe defective. • Two levels of inspections are proposed, e.g., minor and major inspections. • Once the minor defective stage is found, instead of taking a maintenance action, a shortened inspection interval is recommended. • When the severe defective stage is found, we delay the maintenance according to the threshold to the next PM. • The decision variables are the inspection intervals and the threshold to PM

  7. Advancing sustainable development in Canada : policy issues and research needs

    International Nuclear Information System (INIS)

    Eliadis, P.; Slayen, S.

    2003-11-01

    This paper defined 7 policy-relevant issues that advance sustainable development in Canada. These were; (1) urban redesign, (2) freshwater management, (3) eco-region sustainability, (4) impacts of globalization on sustainable development in Canada, (5) designing signals and incentives that promote sustainable behaviour among citizens, (6) reducing the ecological burden of unsustainable lifestyles, and (7) international engagement in sustainable development. The authors questioned why these issues have not made greater progress, given that they have been on national and international agendas since 1972. They also questioned why it is so difficult to integrate environmental and economic signals. Finally, they examined whether enough ecological and political space can be provided to developing countries to achieve sustainable development while enhancing the standard of living in Canada and not threatening critical global systems. 173 refs

  8. Human error recovery failure probability when using soft controls in computerized control rooms

    International Nuclear Information System (INIS)

    Jang, Inseok; Kim, Ar Ryum; Seong, Poong Hyun; Jung, Wondea

    2014-01-01

    Many literatures categorized recovery process into three phases; detection of problem situation, explanation of problem causes or countermeasures against problem, and end of recovery. Although the focus of recovery promotion has been on categorizing recovery phases and modeling recovery process, research related to human recovery failure probabilities has not been perform actively. On the other hand, a few study regarding recovery failure probabilities were implemented empirically. Summarizing, researches that have performed so far have several problems in terms of use in human reliability analysis (HRA). By adopting new human-system interfaces that are based on computer-based technologies, the operation environment of MCRs in NPPs has changed from conventional MCRs to advanced MCRs. Because of the different interfaces between conventional and advanced MCRs, different recovery failure probabilities should be considered in the HRA for advanced MCRs. Therefore, this study carries out an empirical analysis of human error recovery probabilities under an advanced MCR mockup called compact nuclear simulator (CNS). The aim of this work is not only to compile a recovery failure probability database using the simulator for advanced MCRs but also to collect recovery failure probability according to defined human error modes to compare that which human error mode has highest recovery failure probability. The results show that recovery failure probability regarding wrong screen selection was lowest among human error modes, which means that most of human error related to wrong screen selection can be recovered. On the other hand, recovery failure probabilities of operation selection omission and delayed operation were 1.0. These results imply that once subject omitted one task in the procedure, they have difficulties finding and recovering their errors without supervisor's assistance. Also, wrong screen selection had an effect on delayed operation. That is, wrong screen

  9. Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure.

    Directory of Open Access Journals (Sweden)

    Susan Browne

    Full Text Available Those with advanced heart failure (HF experience high levels of morbidity and mortality, similar to common cancers. However, there remains evidence of inequity of access to palliative care services compared to people with cancer. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care.Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (n = 30, carers (n = 20, and professionals (n = 65. Data analysed using Normalisation Process Theory (NPT as the underpinning conceptual framework.Uncertainty is ubiquitous in accounts from advanced HF patients and their caregivers. This uncertainty relates to understanding of the implications of their diagnosis, appropriate treatments, and when and how to seek effective help. Health professionals agree this is a major problem but feel they lack knowledge, opportunities, or adequate support to improve the situation. Fragmented care with lack of coordination and poor communication makes life difficult. Poor understanding of the condition extends to the wider circle of carers and means that requests for help may not be perceived as legitimate, and those with advanced HF are not prioritised for social and financial supports. Patient and caregiver accounts of emergency care are uniformly poor. Managing polypharmacy and enduring concomitant side effects is a major burden, and the potential for rationalisation exists. This study has potential limitations because it was undertaken within a single geographical location within the United Kingdom.Little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health care services that are poorly coordinated and offer fragmented care. There is evidence that these poor experiences could be improved to a large extent by

  10. Legislative and Policy Developments and Imperatives for Advancing the Primary Care Behavioral Health (PCBH) Model.

    Science.gov (United States)

    Freeman, Dennis S; Hudgins, Cathy; Hornberger, Joel

    2018-03-05

    The Primary Care Behavioral Health (PCBH) practice model continues to gain converts among primary care and behavioral health professionals as the evidence supporting its effectiveness continues to accumulate. Despite a growing number of practices and organizations using the model effectively, widespread implementation has been hampered by outmoded policies and regulatory barriers. As policymakers and legislators begin to recognize the contributions that PCBH model services make to the care of complex patients and the expansion of access to those in need of behavioral health interventions, some encouraging policy initiatives are emerging and the policy environment is becoming more favorable to implementation of the PCBH model. This article outlines the necessity for policy change, exposing the policy issues and barriers that serve to limit the practice of the PCBH model; highlights innovative approaches some states are taking to foster integrated practice; and discusses the compatibility of the PCBH model with the nation's health care reform agenda. Psychologists have emerged as leaders in the design and implementation of PCBH model integration and are encouraged to continue to advance the model through the demonstration of efficient and effective clinical practice, participation in the expansion of an appropriately trained workforce, and advocacy for the inclusion of this practice model in emerging healthcare systems and value-based payment methodologies.

  11. Review Paper Heart Failure in Small Animals - Advances in Clinical ...

    African Journals Online (AJOL)

    The rationale for the use of drugs and supportive therapy in the management of heart diseases (HDs) and heart failure (HF), is discussed in the light of contemporary concepts. The in-adequacy of the age-long therapy of heart failure with oxygen supplementation, cardiac glycosides, rest and the withholding of salt in food is ...

  12. 32 CFR 282.4 - Policy.

    Science.gov (United States)

    2010-07-01

    ... certain claim settlement and advance decision functions that, by statute or delegation, are vested in the... SETTLING PERSONNEL AND GENERAL CLAIMS AND PROCESSING ADVANCE DECISION REQUESTS § 282.4 Policy. It is DoD policy that: (a) Claims shall be settled and advance decisions rendered in accordance with all pertinent...

  13. Heart Failure in North America

    OpenAIRE

    Blair, John E. A; Huffman, Mark; Shah, Sanjiv J

    2013-01-01

    Heart failure is a major health problem that affects patients and healthcare systems worldwide. Within the continent of North America, differences in economic development, genetic susceptibility, cultural practices, and trends in risk factors and treatment all contribute to both inter-continental and within-continent differences in heart failure. The United States and Canada represent industrialized countries with similar culture, geography, and advanced economies and infrastructure. During t...

  14. Repetitive use of levosimendan in advanced heart failure

    DEFF Research Database (Denmark)

    Poelzl, Gerhard; Altenberger, Johann; Baholli, Loant

    2017-01-01

    Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive...

  15. Advanced RESTART method for the estimation of the probability of failure of highly reliable hybrid dynamic systems

    International Nuclear Information System (INIS)

    Turati, Pietro; Pedroni, Nicola; Zio, Enrico

    2016-01-01

    The efficient estimation of system reliability characteristics is of paramount importance for many engineering applications. Real world system reliability modeling calls for the capability of treating systems that are: i) dynamic, ii) complex, iii) hybrid and iv) highly reliable. Advanced Monte Carlo (MC) methods offer a way to solve these types of problems, which are feasible according to the potentially high computational costs. In this paper, the REpetitive Simulation Trials After Reaching Thresholds (RESTART) method is employed, extending it to hybrid systems for the first time (to the authors’ knowledge). The estimation accuracy and precision of RESTART highly depend on the choice of the Importance Function (IF) indicating how close the system is to failure: in this respect, proper IFs are here originally proposed to improve the performance of RESTART for the analysis of hybrid systems. The resulting overall simulation approach is applied to estimate the probability of failure of the control system of a liquid hold-up tank and of a pump-valve subsystem subject to degradation induced by fatigue. The results are compared to those obtained by standard MC simulation and by RESTART with classical IFs available in the literature. The comparison shows the improvement in the performance obtained by our approach. - Highlights: • We consider the issue of estimating small failure probabilities in dynamic systems. • We employ the RESTART method to estimate the failure probabilities. • New Importance Functions (IFs) are introduced to increase the method performance. • We adopt two dynamic, hybrid, highly reliable systems as case studies. • A comparison with literature IFs proves the effectiveness of the new IFs.

  16. Defined Engineered Human Myocardium with Advanced Maturation for Applications in Heart Failure Modelling and Repair

    Science.gov (United States)

    Tiburcy, Malte; Hudson, James E.; Balfanz, Paul; Schlick, Susanne; Meyer, Tim; Liao, Mei-Ling Chang; Levent, Elif; Raad, Farah; Zeidler, Sebastian; Wingender, Edgar; Riegler, Johannes; Wang, Mouer; Gold, Joseph D.; Kehat, Izhak; Wettwer, Erich; Ravens, Ursula; Dierickx, Pieterjan; van Laake, Linda W.; Goumans, Marie Jose; Khadjeh, Sara; Toischer, Karl; Hasenfuss, Gerd; Couture, Larry A.; Unger, Andreas; Linke, Wolfgang A.; Araki, Toshiyuki; Neel, Benjamin; Keller, Gordon; Gepstein, Lior; Wu, Joseph C.; Zimmermann, Wolfram-Hubertus

    2017-01-01

    Background Advancing structural and functional maturation of stem cell-derived cardiomyocytes remains a key challenge for applications in disease modelling, drug screening, and heart repair. Here, we sought to advance cardiomyocyte maturation in engineered human myocardium (EHM) towards an adult phenotype under defined conditions. Methods We systematically investigated cell composition, matrix and media conditions to generate EHM from embryonic and induced pluripotent stem cell-derived cardiomyocytes and fibroblasts with organotypic functionality under serum-free conditions. We employed morphological, functional, and transcriptome analyses to benchmark maturation of EHM. Results EHM demonstrated important structural and functional properties of postnatal myocardium, including: (1) rod-shaped cardiomyocytes with M-bands assembled as a functional syncytium; (2) systolic twitch forces at a similar level as observed in bona fide postnatal myocardium; (3) a positive force-frequency-response; (4) inotropic responses to β-adrenergic stimulation mediated via canonical β1- and β2-adrenoceptor signaling pathways; and (5) evidence for advanced molecular maturation by transcriptome profiling. EHM responded to chronic catecholamine toxicity with contractile dysfunction, cardiomyocyte hypertrophy, cardiomyocyte death, and NT-proBNP release; all are classical hallmarks of heart failure. Additionally, we demonstrate scalability of EHM according to anticipated clinical demands for cardiac repair. Conclusions We provide proof-of-concept for a universally applicable technology for the engineering of macro-scale human myocardium for disease modelling and heart repair from embryonic and induced pluripotent stem cell-derived cardiomyocytes under defined, serum-free conditions. PMID:28167635

  17. Defined Engineered Human Myocardium With Advanced Maturation for Applications in Heart Failure Modeling and Repair.

    Science.gov (United States)

    Tiburcy, Malte; Hudson, James E; Balfanz, Paul; Schlick, Susanne; Meyer, Tim; Chang Liao, Mei-Ling; Levent, Elif; Raad, Farah; Zeidler, Sebastian; Wingender, Edgar; Riegler, Johannes; Wang, Mouer; Gold, Joseph D; Kehat, Izhak; Wettwer, Erich; Ravens, Ursula; Dierickx, Pieterjan; van Laake, Linda W; Goumans, Marie Jose; Khadjeh, Sara; Toischer, Karl; Hasenfuss, Gerd; Couture, Larry A; Unger, Andreas; Linke, Wolfgang A; Araki, Toshiyuki; Neel, Benjamin; Keller, Gordon; Gepstein, Lior; Wu, Joseph C; Zimmermann, Wolfram-Hubertus

    2017-05-09

    Advancing structural and functional maturation of stem cell-derived cardiomyocytes remains a key challenge for applications in disease modeling, drug screening, and heart repair. Here, we sought to advance cardiomyocyte maturation in engineered human myocardium (EHM) toward an adult phenotype under defined conditions. We systematically investigated cell composition, matrix, and media conditions to generate EHM from embryonic and induced pluripotent stem cell-derived cardiomyocytes and fibroblasts with organotypic functionality under serum-free conditions. We used morphological, functional, and transcriptome analyses to benchmark maturation of EHM. EHM demonstrated important structural and functional properties of postnatal myocardium, including: (1) rod-shaped cardiomyocytes with M bands assembled as a functional syncytium; (2) systolic twitch forces at a similar level as observed in bona fide postnatal myocardium; (3) a positive force-frequency response; (4) inotropic responses to β-adrenergic stimulation mediated via canonical β 1 - and β 2 -adrenoceptor signaling pathways; and (5) evidence for advanced molecular maturation by transcriptome profiling. EHM responded to chronic catecholamine toxicity with contractile dysfunction, cardiomyocyte hypertrophy, cardiomyocyte death, and N-terminal pro B-type natriuretic peptide release; all are classical hallmarks of heart failure. In addition, we demonstrate the scalability of EHM according to anticipated clinical demands for cardiac repair. We provide proof-of-concept for a universally applicable technology for the engineering of macroscale human myocardium for disease modeling and heart repair from embryonic and induced pluripotent stem cell-derived cardiomyocytes under defined, serum-free conditions. © 2017 American Heart Association, Inc.

  18. Industrial clusters in the Finnish economy. Strategies and policy implications

    International Nuclear Information System (INIS)

    Luukkainen, S.

    2001-04-01

    Technology is currently the most important determinant of the long-term economic growth as it explains for at least half of the growth of the industrialised nations. Economists have demonstrated that R and D performed by the innovating company generates widespread value in the economy through technology diffusion. The objective of the private financing is, however, to increase the value of the innovating company and the spillovers to other companies are there not so important. The market failure created by the R and D spillovers is thus one of the main justifications for government policies. The advancement of spillovers by government's actions can be called cluster policy. The objective of this study is to produce knowledge to support decision making in the realisation of an efficient cluster-oriented technology policy. The Finnish industrial clusters are identified by a quantitative value chain analysis, and their economic profiles are analysed. Also, a solid framework is presented that describes how to evaluate the economic impacts of a R and D project from the cluster policy point of view. The clusters should be seen as a technology policy tools, by which the domestic industrial structures can be analysed and developed. In this kind of decision making it is important to understand the mechanisms of technology diffusion. Concrete technology policy occurs in the selection of the publicly financed R and D projects. In the selection of the supported-projects it is crucial to evaluate the economic impacts of project proposals in advance. That is why economic indicators like measures of spillovers are needed The governments should fund R and D projects that have the highest social rate of return and would otherwise be underfunded or delayed. (orig.)

  19. Policy Failures in the Graveyard of Empires: How Policymakers Let the Soldiers Down in the British, the Soviet, and the American Wars in Afghanistan

    Science.gov (United States)

    2011-05-19

    Afghanistan’s history and its socio -cultural environment, the study critically analyzes the negative impact of policy failures - acts of both omission as well...wars in Afghanistan. Set in the context of Afghanistan’s history and its socio -cultural environment, the study critically analyzes the negative... franchise and Westminster democracy. 83 Rubin, The Fragmentation of Afghanistan, 28

  20. Milrinone in advanced heart failure: dose and therapeutic monitor outside intensive care unit.

    Science.gov (United States)

    Charisopoulou, Dafni; Leaver, Neil; Banner, Nicholas R

    2014-04-01

    Advanced chronic heart failure (ACHF) patients often require inotropes before transplantation or ventricular assist device implantation. Milrinone, an inotrope and vasodilator, may accumulate in cardiorenal syndrome with serious adverse effects. We investigated the potential for therapeutic drug monitoring of milrinone levels using High Performance Liquid Chromatography Mass Spectrometry (HPLC-MS). 22 ACHF patients (15 males, 49±9 years) received milrinone 50 µg/kg intravenously (i.v.) during heart catheterization. Milrinone levels were 216±71 ng/ml (within the reported therapeutic range: 100-300 ng/ml), followed by improvements in cardiac index, pulmonary artery and wedge pressures (p milrinone (5-26 days) at 0.1-0.2 µg/kg/min, titrated according to plasma milrinone levels. No adverse events occurred. Therapeutic levels were achieved with doses of 0.2±0.06 µg/Kg/min, below those recommended in Summary of Product Characteristics. Milrinone therapy can be noninvasively monitored by HPLC-MS, while avoiding toxicity in ACHF.

  1. Barriers and facilitators to end-of-life communication in advanced chronic organ failure.

    Science.gov (United States)

    Van den Heuvel, Liza Amc; Spruit, Martijn A; Schols, Jos Mga; Hoving, Ciska; Wouters, Emiel Fm; Janssen, Daisy Ja

    2016-05-01

    The aim of this quantitative, cross-sectional study was to identify barriers and facilitators to end-of-life communication experienced by family caregivers of patients with advanced chronic organ failure and to examine agreement in barriers and facilitators between family caregivers and patients. Patients and family caregivers were interviewed using the barriers and facilitators questionnaire. Agreement was determined using intraclass correlation coefficients for continuous variables and Cohen's kappa for categorical variables. A total of 158 patients and family caregiver dyads were included. The most important barriers for family caregivers were related to uncertainty about expected care and focus on staying alive instead of dying. The facilitators were related to trust in and competence of their physician and earlier experiences with death in their (social) environment. For most barriers and facilitators, agreement between patients and family caregivers was fair to moderate. Differences in barriers and facilitators between patients and family caregivers ask for an individual approach to facilitate end-of-life communication.

  2. The inodilator levosimendan in repetitive doses in the treatment of advanced heart failure

    Science.gov (United States)

    Delgado, Juan F.; Oliva, Fabrizio; Reinecke, Alexander

    2017-01-01

    Abstract Inotropes may be an appropriate response for some patients with advanced heart failure who remain highly symptomatic despite optimization of evidence-based therapy. These patients need to be supported waiting for a heart transplant or ventricular assist device, or may be candidates for inotropy as an intervention in its own right to maintain a patient in the best achievable circumstances. Objectives in such a situation include relieving symptoms, improving quality of life and reducing unplanned hospitalizations and the costs associated with such admissions. Levosimendan, a calcium sensitizer and potassium channel opener with inotrope and vasodilator actions, has emerged as a potentially valuable addition to the armamentarium in this context, used in repeated or intermittent cycles of therapy. Detailed proposals and guidance are offered for the identification of candidate patients with good prospects of a beneficial response to levosimendan, and for the safe and effective implementation of a course of therapy. PMID:29249905

  3. Advancing Strategies for Agenda Setting by Health Policy Coalitions: A Network Analysis of the Canadian Chronic Disease Prevention Survey.

    Science.gov (United States)

    McGetrick, Jennifer Ann; Raine, Kim D; Wild, T Cameron; Nykiforuk, Candace I J

    2018-06-11

    Health in all policies can address chronic disease morbidity and mortality by increasing population-level physical activity and healthy eating, and reducing tobacco and alcohol use. Both governmental and nongovernmental policy influencers are instrumental for health policy that modifies political, economic, and social environments. Policy influencers are informed and persuaded by coalitions that support or oppose changing the status quo. Empirical research examining policy influencers' contact with coalitions, as a social psychological exposure with health policy outcomes, can benefit from application of health communication theories. Accordingly, we analyzed responses to the 2014 Chronic Disease Prevention Survey for 184 Canadian policy influencers employed in provincial governments, municipalities, large workplaces, school boards, and the media. In addition to contact levels with coalitions, respondents' jurisdiction, organization, and ideology were analyzed as potential moderators. Calculating authority score centrality using network analysis, we determined health policy supporters to be more central in policy influencer networks, and theorized their potential to impact health policy public agenda setting via priming and framing processes. We discuss the implications of our results as presenting opportunities to more effectively promote health policy through priming and framing by coordinating coalitions across risk behaviors to advance a societal imperative for chronic disease prevention.

  4. Seeds of Failure in Colbert's Baltic Policy.

    Science.gov (United States)

    Mackey, Richard William

    1984-01-01

    This investigation of French mercantilist initiatives and policies in the seventeenth century focuses on the attempts of Colbert, the controller general of finance to Louis XIV, to stimulate French trade with the Baltic by establishing a Company of the North. (RM)

  5. Emerging energy technologies impacts and policy implications

    International Nuclear Information System (INIS)

    Grubb, M.

    1992-01-01

    Technical change is a key factor in the energy world. Failure to recognize the potential for technical change, and the pace at which it may occur, has limited the accuracy and usefulness of past energy projections. conversely, programs to develop and deploy advanced energy technologies have often proved disappointing in the face of technical and commercial obstacles. This book examines important new and emerging energy technologies, and the mechanisms by which they may develop and enter the market. The project concentrates on the potential and probable role of selected energy technologies-which are in existence and likely to be of rapidly growing importance over the next decade-and the way in which market conditions and policy environment may affect their implementation

  6. Regulation of Telecommunications: The Choice Between Market and Regulatory Failures

    Directory of Open Access Journals (Sweden)

    Dmitrii Trubnikov

    2017-04-01

    Full Text Available Purpose – The paper examines the main regulatory frameworks of the telecommunications industry through the concept of market failure and analyses how and why the policy often leads to undesirable outcomes that might be considered as regulatory failure. Methodology/approach/design – The research uses the EU regulatory framework for electronic communications as a base for the analysis of the main policy objectives through the prism of the market failure theory with an eye to the interests of the main market players in the telecommunications markets. Findings – About any aspect of regulation allows to find ways to create opportunities for some groups of the industry and stifle activity of others. Despite the theory of market failure provides reasonable justifications for regulation of telecommunications markets, it is possible to argue that many of these problems are mainly the consequence of the policy and could be better solved by market mechanisms. Originality/value – The results of the research allow to look at the problems of telecommunications development and issues of the high level of concentration of the telecommunications markets as regulatory formed problems rather than consequences of the inherited industry’s characteristics.

  7. Economics and rational conservation policy

    International Nuclear Information System (INIS)

    Metcalf, G.E.

    1994-01-01

    Energy analysts have been concerned with the apparently low level of energy-efficient investments and have suggested the presence of various market barriers and failures that hinder investment. The concept of a barrier as defined here is some force that is working against investment in energy-efficient technologies. Market failures, on the other hand, are failures of the competitive paradigm that lead to economically inefficient outcomes. Market barriers require no particular response on the part of government while market failures may call for some policy response. (author)

  8. Predicting short-term mortality in advanced decompensated heart failure - role of the updated acute decompensated heart failure/N-terminal pro-B-type natriuretic Peptide risk score.

    Science.gov (United States)

    Scrutinio, Domenico; Ammirati, Enrico; Passantino, Andrea; Guida, Pietro; D'Angelo, Luciana; Oliva, Fabrizio; Ciccone, Marco Matteo; Iacoviello, Massimo; Dentamaro, Ilaria; Santoro, Daniela; Lagioia, Rocco; Sarzi Braga, Simona; Guzzetti, Daniela; Frigerio, Maria

    2015-01-01

    The first few months after admission are the most vulnerable period in patients with acute decompensated heart failure (ADHF). We assessed the association of the updated ADHF/N-terminal pro-B-type natriuretic peptide (NT-proBNP) risk score with 90-day and in-hospital mortality in 701 patients admitted with advanced ADHF, defined as severe symptoms of worsening HF, severely depressed left ventricular ejection fraction, and the need for i.v. diuretic and/or inotropic drugs. A total of 15.7% of the patients died within 90 days of admission and 5.2% underwent ventricular assist device (VAD) implantation or urgent heart transplantation (UHT). The C-statistic of the ADHF/NT-proBNP risk score for 90-day mortality was 0.810 (95% CI: 0.769-0.852). Predicted and observed mortality rates were in close agreement. When the composite outcome of death/VAD/UHT at 90 days was considered, the C-statistic decreased to 0.741. During hospitalization, 7.6% of the patients died. The C-statistic for in-hospital mortality was 0.815 (95% CI: 0.761-0.868) and Hosmer-Lemeshow χ(2)=3.71 (P=0.716). The updated ADHF/NT-proBNP risk score outperformed the Acute Decompensated Heart Failure National Registry, the Organized Program to Initiate Lifesaving Treatment in Patients Hospitalized for Heart Failure, and the American Heart Association Get with the Guidelines Program predictive models. Updated ADHF/NT-proBNP risk score is a valuable tool for predicting short-term mortality in severe ADHF, outperforming existing inpatient predictive models.

  9. Credit Ratings Failures and Policy Options

    OpenAIRE

    Marco Pagano; Paolo Volpin

    2009-01-01

    This paper examines the role of credit rating agencies in the subprime crisis that triggered the 2007-2008 financial turmoil. We focus on two aspects of ratings that contributed to the boom and bust of the market for structured debt: rating inflation and coarse information disclosure. The paper discusses how regulation can be designed to mitigate these problems in the future. Our preferred policy is to require rating agencies to be paid by investors rather than by issuers and to grant open an...

  10. Simulations of Failure via Three-Dimensional Cracking in Fuel Cladding for Advanced Nuclear Fuels

    International Nuclear Information System (INIS)

    Lu, Hongbing; Bukkapatnam, Satish; Harimkar, Sandip; Singh, Raman; Bardenhagen, Scott

    2014-01-01

    Enhancing performance of fuel cladding and duct alloys is a key means of increasing fuel burnup. This project will address the failure of fuel cladding via three-dimensional cracking models. Researchers will develop a simulation code for the failure of the fuel cladding and validate the code through experiments. The objective is to develop an algorithm to determine the failure of fuel cladding in the form of three-dimensional cracking due to prolonged exposure under varying conditions of pressure, temperature, chemical environment, and irradiation. This project encompasses the following tasks: 1. Simulate 3D crack initiation and growth under instantaneous and/or fatigue loads using a new variant of the material point method (MPM); 2. Simulate debonding of the materials in the crack path using cohesive elements, considering normal and shear traction separation laws; 3. Determine the crack propagation path, considering damage of the materials incorporated in the cohesive elements to allow the energy release rate to be minimized; 4. Simulate the three-dimensional fatigue crack growth as a function of loading histories; 5. Verify the simulation code by comparing results to theoretical and numerical studies available in the literature; 6. Conduct experiments to observe the crack path and surface profile in unused fuel cladding and validate against simulation results; and 7. Expand the adaptive mesh refinement infrastructure parallel processing environment to allow adaptive mesh refinement at the 3D crack fronts and adaptive mesh merging in the wake of cracks. Fuel cladding is made of materials such as stainless steels and ferritic steels with added alloying elements, which increase stability and durability under irradiation. As fuel cladding is subjected to water, chemicals, fission gas, pressure, high temperatures, and irradiation while in service, understanding performance is essential. In the fast fuel used in advanced burner reactors, simulations of the nuclear

  11. Simulations of Failure via Three-Dimensional Cracking in Fuel Cladding for Advanced Nuclear Fuels

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Hongbing [Univ. of Texas, Austin, TX (United States); Bukkapatnam, Satish; Harimkar, Sandip; Singh, Raman; Bardenhagen, Scott

    2014-01-09

    Enhancing performance of fuel cladding and duct alloys is a key means of increasing fuel burnup. This project will address the failure of fuel cladding via three-dimensional cracking models. Researchers will develop a simulation code for the failure of the fuel cladding and validate the code through experiments. The objective is to develop an algorithm to determine the failure of fuel cladding in the form of three-dimensional cracking due to prolonged exposure under varying conditions of pressure, temperature, chemical environment, and irradiation. This project encompasses the following tasks: 1. Simulate 3D crack initiation and growth under instantaneous and/or fatigue loads using a new variant of the material point method (MPM); 2. Simulate debonding of the materials in the crack path using cohesive elements, considering normal and shear traction separation laws; 3. Determine the crack propagation path, considering damage of the materials incorporated in the cohesive elements to allow the energy release rate to be minimized; 4. Simulate the three-dimensional fatigue crack growth as a function of loading histories; 5. Verify the simulation code by comparing results to theoretical and numerical studies available in the literature; 6. Conduct experiments to observe the crack path and surface profile in unused fuel cladding and validate against simulation results; and 7. Expand the adaptive mesh refinement infrastructure parallel processing environment to allow adaptive mesh refinement at the 3D crack fronts and adaptive mesh merging in the wake of cracks. Fuel cladding is made of materials such as stainless steels and ferritic steels with added alloying elements, which increase stability and durability under irradiation. As fuel cladding is subjected to water, chemicals, fission gas, pressure, high temperatures, and irradiation while in service, understanding performance is essential. In the fast fuel used in advanced burner reactors, simulations of the nuclear

  12. How do policy advisors and practitioners prioritise the protection of children from secondhand smoke exposure in a country with advanced tobacco control policy?

    Science.gov (United States)

    Ritchie, Deborah Doreen; Amos, Amanda; Shaw, April; O'Donnell, Rachel; Semple, Sean; Turner, Steve; Martin, Claudia

    2015-01-01

    The aim is to extend understanding of the policy and practice discourses that inform the development of national tobacco control policy to protect children from secondhand smoke exposure (SHSE) in the home, particularly in a country with successful implementation of smoke-free public places legislation. The Scottish experience will contribute to the tobacco control community, particularly those countries at a similar level of tobacco control, as normalising discourses about protecting children from SHSE are becoming more widespread. Case study design using qualitative interviews and focus groups (FGs) with policy makers, health and childcare practitioners during which they were presented with the findings of the Reducing Families' Exposure to Secondhand Smoke (REFRESH) intervention and discussed the implications for their policy and practice priorities. Scotland, UK PARTICIPANTS: Qualitative interviews and FGs were conducted with 30 policy makers and practitioners who were purposively recruited. Participants accepted the harm of SHSE to children; however, action is limited by political expedience due to-the perception of a shift of the public health priority from smoking to alcohol, current financial constraints, more immediate child protection concerns and continuing unresolved ethical arguments. In a country, such as Scotland, with advanced tobacco control strategies, there continue to be challenges to policy and practice development in the more contentious arena of the home. Children's SHSE in their homes is unequivocally accepted as an important health priority, but it is not currently perceived to be a top public health priority in Scotland. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  13. Submandibular gland-sparing radiation therapy for locally advanced oropharyngeal squamous cell carcinoma: patterns of failure and xerostomia outcomes

    International Nuclear Information System (INIS)

    Gensheimer, Michael F; Liao, Jay J; Garden, Adam S; Laramore, George E; Parvathaneni, Upendra

    2014-01-01

    Saliva from submandibular glands (SMG) is necessary to minimize xerostomia. It is unclear whether SMG can be safely spared in patients undergoing bilateral neck radiotherapy for locally advanced oropharyngeal cancer without increasing the risk of marginal recurrence. We evaluated the outcomes of contralateral submandibular gland (cSMG) sparing intensity-modulated radiation therapy (IMRT). All patients with stage III/IV oropharyngeal squamous cell carcinoma treated with bilateral neck IMRT from 2006–2012 at our institution were included. Appropriately selected patients with favorable primary tumor characteristics and no definite contralateral neck disease were treated with cSMG-sparing IMRT. Patterns of failure and xerostomia outcomes were retrospectively analyzed. 114 patients were treated. 89% had stage IV disease and 89% received definitive radiation therapy. 76 patients (67%) received cSMG sparing IMRT. With a median follow-up of 30 months, there were 10 local, 9 regional, and 10 distant recurrences. 2-year overall survival was 86% and 2-year loco-regional control was 87%. In cSMG spared patients, the mean cSMG dose was 30.7 Gy. Late grade 2+ xerostomia was significantly reduced in the cSMG spared group compared to those without SMG sparing (6 months: 23% vs. 72%, 12 months: 6% vs. 41%, 24 months: 3% vs. 36%, all p < 0.0007). There were no peri-SMG marginal recurrences in the cSMG-spared cohort. cSMG sparing IMRT did not increase marginal failures in this series of locally advanced oropharyngeal SCC patients. Xerostomia was significantly reduced in cSMG spared patients

  14. Cost-Effectiveness of Ventricular Assist Device Destination Therapy for Advanced Heart Failure in Duchenne Muscular Dystrophy.

    Science.gov (United States)

    Magnetta, Defne A; Kang, JaHyun; Wearden, Peter D; Smith, Kenneth J; Feingold, Brian

    2018-05-17

    Destination ventricular assist device therapy (DT-VAD) is well accepted in select adults with medically refractory heart failure (HF) who are not transplant candidates; however, its use in younger patients with progressive diseases is unclear. We sought to evaluate the cost-effectiveness of DT-VAD in Duchenne muscular dystrophy (DMD) patients with advanced HF. We created a Markov-state transition model (5-year horizon) to compare survival, costs, and quality of life (QOL) between medical management and DT-VAD in DMD with advanced HF. Model input parameters were derived from the literature. We used sensitivity analyses to explore uncertainty around model assumptions. DT-VAD had higher costs ($435,602 vs. $125,696), survival (3.13 vs. 0.60 years), and quality-adjusted survival (1.99 vs. 0.26 years) than medical management. The incremental cost-effectiveness ratio (ICER) for DT-VAD was $179,086 per quality-adjusted life year (QALY). In sensitivity analyses that were widely varied to account for uncertainty in model assumptions, the DT-VAD strategy generally remained more costly and effective than medical management. Only when VAD implantation costs were <$113,142 did the DT-VAD strategy fall below the $100,000/QALY willingness-to-pay threshold commonly considered to be "cost-effective." In this exploratory analysis, DT-VAD for patients with DMD and advanced HF exceeded societal expectations for cost-effectiveness but had an ICER similar to the accepted practice of DT-VAD in adult HF patients. While more experience and research in this population is needed, our analysis suggests that DT-VAD for advanced HF in DMD should not be dismissed solely based on cost.

  15. Periodic imperfect preventive maintenance with two categories of competing failure modes

    Energy Technology Data Exchange (ETDEWEB)

    Zequeira, R.I. [ISTIT FRE CNRS 2732-Equipe LM2S, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes (France)]. E-mail: romulo.zequeira@utt.fr; Berenguer, C. [ISTIT FRE CNRS 2732-Equipe LM2S, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes (France)]. E-mail: christophe.berenguer@utt.fr

    2006-04-15

    A maintenance policy is studied for a system with two types of failure modes: maintainable and non-maintainable. The quality of maintenance actions is modelled by its effect on the system failure rate. Preventive maintenance actions restore the system to a condition between as good as new and as bad as immediately before the maintenance action. The model presented permits to study the equipment condition improvement (improvement factor) as a function of the time of the preventive maintenance action. The determination of the maintenance policy, which minimizes the cost rate for an infinite time span, is examined. Conditions are given under which a unique optimal policy exists.

  16. Periodic imperfect preventive maintenance with two categories of competing failure modes

    International Nuclear Information System (INIS)

    Zequeira, R.I.; Berenguer, C.

    2006-01-01

    A maintenance policy is studied for a system with two types of failure modes: maintainable and non-maintainable. The quality of maintenance actions is modelled by its effect on the system failure rate. Preventive maintenance actions restore the system to a condition between as good as new and as bad as immediately before the maintenance action. The model presented permits to study the equipment condition improvement (improvement factor) as a function of the time of the preventive maintenance action. The determination of the maintenance policy, which minimizes the cost rate for an infinite time span, is examined. Conditions are given under which a unique optimal policy exists

  17. Policy Integration and Multi-Level Governance: Dealing with the Vertical Dimension of Policy Mix Designs

    Directory of Open Access Journals (Sweden)

    Michael Howlett

    2017-05-01

    Full Text Available Multifaceted problems such as sustainable development typically involve complex arrangements of institutions and instruments and the subject of how best to design and operate such ‘mixes’, ‘bundles’ or ‘portfolios’ of policy tools is an ongoing issue in this area. One aspect of this question is that some mixes are more difficult to design and operate than others. The paper argues that, ceteris paribus, complex policy-making faces substantial risks of failure when horizontal or vertical dimensions of policy-making are not well integrated. The paper outlines a model of policy mix types which highlights the design problems associated with more complex arrangements and presents two case studies of similarly structured mixes in the areas of marine parks in Australia and coastal zone management in Europe—one a failure and the other a successful case of integration—to illustrate how such mixes can be better designed and managed more effectively.

  18. BWR fuel performance under advanced water chemistry conditions – a delicate journey towards zero fuel failures – a review

    International Nuclear Information System (INIS)

    Hettiarachchi, S.

    2015-01-01

    Boiling Water Reactors (BWRs) have undergone a variety of chemistry evolutions over the past few decades as a result of the need to control stress corrosion cracking of reactor internals, radiation fields and personnel exposure. Some of the advanced chemistry changes include hydrogen addition, zinc addition, iron reduction using better filtration technologies, and more recently noble metal chemical addition to many of the modern day operating BWRs. These water chemistry evolutions have resulted in changes in the crud distribution on fuel cladding material, Co-60 levels and the Rod oxide thickness (ROXI) measurements using the conventional eddy current techniques. A limited number of Post-Irradiation Examinations (PIE) of fuel rods that exhibited elevated oxide thickness using eddy current techniques showed that the actual oxide thickness by metallography is much lower. The difference in these observations is attributed to the changing magnetic properties of the crud affecting the rod oxide thickness measurement by the eddy current technique. This paper will review and summarize the BWR fuel cladding performance under these advanced and improved water chemistry conditions and how these changes have affected the goal to reach zero fuel failures. The paper will also provide a brief summary of some of the results of hot cell PIE, results of crud composition evaluation, crud spallation, oxide thickness measurements, hydrogen content in the cladding and some fuel failure observations. (author) Key Words: Boiling Water Reactor, Fuel Performance, Hydrogen Addition, Zinc Addition, Noble Metal Chemical Addition, Zero Leakers

  19. On-Board Particulate Filter Failure Prevention and Failure Diagnostics Using Radio Frequency Sensing

    Energy Technology Data Exchange (ETDEWEB)

    Sappok, Alex [Filter Sensing Technologies; Ragaller, Paul [Filter Sensing Technologies; Herman, Andrew [CTS Corporation; Bromberg, L. [Massachusetts Institute of Technology (MIT); Prikhodko, Vitaly Y [ORNL; Parks, II, James E [ORNL; Storey, John Morse [ORNL

    2017-01-01

    The increasing use of diesel and gasoline particulate filters requires advanced on-board diagnostics (OBD) to prevent and detect filter failures and malfunctions. Early detection of upstream (engine-out) malfunctions is paramount to preventing irreversible damage to downstream aftertreatment system components. Such early detection can mitigate the failure of the particulate filter resulting in the escape of emissions exceeding permissible limits and extend the component life. However, despite best efforts at early detection and filter failure prevention, the OBD system must also be able to detect filter failures when they occur. In this study, radio frequency (RF) sensors were used to directly monitor the particulate filter state of health for both gasoline particulate filter (GPF) and diesel particulate filter (DPF) applications. The testing included controlled engine dynamometer evaluations, which characterized soot slip from various filter failure modes, as well as on-road fleet vehicle tests. The results show a high sensitivity to detect conditions resulting in soot leakage from the particulate filter, as well as potential for direct detection of structural failures including internal cracks and melted regions within the filter media itself. Furthermore, the measurements demonstrate, for the first time, the capability to employ a direct and continuous monitor of particulate filter diagnostics to both prevent and detect potential failure conditions in the field.

  20. Napoleon’s Strategic Failures

    Science.gov (United States)

    2011-03-15

    of Napoleon‟s strategic naval failures was his obsession with invading Ireland as a way to get at England. There had been numerous occasions where...policies impacting the internal economies of Europe was the significant rise in prices for such items as coffee , saffron, spices and sugar. These

  1. Safety policy for nuclear power development

    International Nuclear Information System (INIS)

    Uchida, Hideo

    1987-01-01

    The report discusses various aspects of the safety policy for nuclear power development in Japan. Nuclear power development over three decades in Japan has led to operating performance which is highly safe and reliable. This has been appreciated internationally. Discussed here is the Japanese basic safety policy for nuclear power development that is essential first to design, manufacture and construction using high technology. The current careful quality assurance and reliable operation management by skilled operators are relied upon, on the basis of the fact that measures to prevent abnormal events are given first priority rather than those to mitigate consequences of abnormal events or accidents. Lessons learned from accidents and failures within or outside Japan such as the TMI accident and Chernobyl accident have been reflected in the improvement of safety through careful and thorough examinations of them. For further improvement in nuclear safety, deliberate studies and investigations on severe accidents and probabilistic safety assessment are considered to be important. Such efforts are currently being promoted. For this purpose, it is important to advance international cooperation and continue technical exchanges, based on operation experience in nuclear power stations in Japan. (Nogami, K.)

  2. Nature as capital: Advancing and incorporating ecosystem services in United States federal policies and programs.

    Science.gov (United States)

    Schaefer, Mark; Goldman, Erica; Bartuska, Ann M; Sutton-Grier, Ariana; Lubchenco, Jane

    2015-06-16

    The concept of nature as capital is gaining visibility in policies and practices in both the public and private sectors. This change is due to an improved ability to assess and value ecosystem services, as well as to a growing recognition of the potential of an ecosystem services approach to make tradeoffs in decision making more transparent, inform efficient use of resources, enhance resilience and sustainability, and avoid unintended negative consequences of policy actions. Globally, governments, financial institutions, and corporations have begun to incorporate natural capital accounting in their policies and practices. In the United States, universities, nongovernmental organizations, and federal agencies are actively collaborating to develop and apply ecosystem services concepts to further national environmental and economic objectives. Numerous federal agencies have begun incorporating these concepts into land use planning, water resources management, and preparations for, and responses to, climate change. Going forward, well-defined policy direction will be necessary to institutionalize ecosystem services approaches in federal agencies, as well as to guide intersector and interdisciplinary collaborative research and development efforts. In addition, a new generation of decision support tools are needed to further the practical application of ecosystem services principles in policymaking and commercial activities. Improved performance metrics are needed, as are mechanisms to monitor the status of ecosystem services and assess the environmental and economic impacts of policies and programs. A greater national and international financial commitment to advancing ecosystem services and natural capital accounting would likely have broad, long-term economic and environmental benefits.

  3. Technology integration box beam failure study

    Science.gov (United States)

    Shuart, M. J.; Ambur, Damodar R.; Davis, D. D., Jr.; Davis, R. C.; Farley, G. L.; Lotts, C. G.; Wang, J. T.

    1993-01-01

    Composite structures have the potential to be cost-effective, structurally efficient primary aircraft structures. The Advanced Composites Technology (ACT) Program has the goal to develop the technology to exploit this potential for heavily loaded aircraft structures. As part of the ACT Program, Lockheed Aeronautical Systems Company completed the design and fabrication of the Technology Integration Box Beam (TIBB). The TIBB is an advanced composite prototype structure for the center wing section of the C-130 aircraft. Lockheed subjected the TIBB to downbending, upbending, torsion and combined upbending and torsion load conditions to verify the design. The TIBB failed at 83 percent of design ultimate load for the combined upbending and torsion load condition. The objective of this paper is to describe the mechanisms that led to the failure of the TIBB. The results of a comprehensive analytical and experimental study are presented. Analytical results include strain and deflection results from both a global analysis of the TIBB and a local analysis of the failure region. These analytical results are validated by experimental results from the TIBB tests. The analytical and experimental results from the TIBB tests are used to determine a sequence of events that resulted in failure of the TIBB. A potential cause of failure is high stresses in a stiffener runout region. Analytical and experimental results are also presented for a stiffener runout specimen that was used to simulate the TIBB failure mechanisms.

  4. Mining environmental policy: comparing Indonesia and the USA

    Energy Technology Data Exchange (ETDEWEB)

    Michael S. Hamilton [University of Southern Maine in Portland, MA (United States)

    2005-12-15

    Illustrated by a detailed comparative examination of mining regulations and environmental impact assessment (EIA) in the USA (the second largest producer of coal in the world) and Indonesia (the eighth largest and most rapidly growing), this book argues that the degree of policy integration often determines the success or failure in controlling environmental effects of mining operations. Comparison of surface mining regulation in the two countries provides some stark contrasts, some surprising results concerning the diffusion of policy innovations from one country to another, and instances of both policy success and failure. The book provides significant new insights into international relations and comparative environmental policy, particularly as they affect rainforests and biodiversity. It also suggests that if mining environmental policy were to be effectively implemented, the environmental degradation caused need not be permanent. Contents: Introduction: mining environmental policy implementation in two countries; Mining regulatory policy in Indonesia; Mining regulatory policy in the United States; Environmental assessment policy in two countries; Lost profits, royalties, and environmental quality; Developing mining environmental policy in Indonesia; Improving Indonesian regulatory program; Development of institutional capacity; Motivations for assistance; Conclusions.

  5. Mechanical Circulatory Support for Advanced Heart Failure: Are We about to Witness a New "Gold Standard"?

    Science.gov (United States)

    Capoccia, Massimo

    2016-12-12

    The impact of left ventricular assist devices (LVADs) for the treatment of advanced heart failure has played a significant role as a bridge to transplant and more recently as a long-term solution for non-eligible candidates. Continuous flow left ventricular assist devices (CF-LVADs), based on axial and centrifugal design, are currently the most popular devices in view of their smaller size, increased reliability and higher durability compared to pulsatile flow left ventricular assist devices (PF-LVADs). The trend towards their use is increasing. Therefore, it has become mandatory to understand the physics and the mathematics behind their mode of operation for appropriate device selection and simulation set up. For this purpose, this review covers some of these aspects. Although very successful and technologically advanced, they have been associated with complications such as pump thrombosis, haemolysis, aortic regurgitation, gastro-intestinal bleeding and arterio-venous malformations. There is perception that the reduced arterial pulsatility may be responsible for these complications. A flow modulation control approach is currently being investigated in order to generate pulsatility in rotary blood pumps. Thrombus formation remains the most feared complication that can affect clinical outcome. The development of a preoperative strategy aimed at the reduction of complications and patient-device suitability may be appropriate. Patient-specific modelling based on 3D reconstruction from CT-scan combined with computational fluid dynamic studies is an attractive solution in order to identify potential areas of stagnation or challenging anatomy that could be addressed to achieve the desired outcome. The HeartMate II (axial) and the HeartWare HVAD (centrifugal) rotary blood pumps have been now used worldwide with proven outcome. The HeartMate III (centrifugal) is now emerging as the new promising device with encouraging preliminary results. There are now enough pumps on

  6. Government Cloud Computing Policies: Potential Opportunities for Advancing Military Biomedical Research.

    Science.gov (United States)

    Lebeda, Frank J; Zalatoris, Jeffrey J; Scheerer, Julia B

    2018-02-07

    indicated that the security infrastructure in cloud services may be more compliant with the Health Insurance Portability and Accountability Act of 1996 regulations than traditional methods. To gauge the DoD's adoption of cloud technologies proposed metrics included cost factors, ease of use, automation, availability, accessibility, security, and policy compliance. Since 2009, plans and policies were developed for the use of cloud technology to help consolidate and reduce the number of data centers which were expected to reduce costs, improve environmental factors, enhance information technology security, and maintain mission support for service members. Cloud technologies were also expected to improve employee efficiency and productivity. Federal cloud computing policies within the last decade also offered increased opportunities to advance military healthcare. It was assumed that these opportunities would benefit consumers of healthcare and health science data by allowing more access to centralized cloud computer facilities to store, analyze, search and share relevant data, to enhance standardization, and to reduce potential duplications of effort. We recommend that cloud computing be considered by DoD biomedical researchers for increasing connectivity, presumably by facilitating communications and data sharing, among the various intra- and extramural laboratories. We also recommend that policies and other guidances be updated to include developing additional metrics that will help stakeholders evaluate the above mentioned assumptions and expectations. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2018. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  7. Efficacy and safety of icotinib in Chinese patients with advanced non-small cell lung cancer after failure of chemotherapy.

    Science.gov (United States)

    Shao, Lan; Zhang, Beibei; He, Chunxiao; Lin, Baochai; Song, Zhengbo; Lou, Guangyuan; Yu, Xinmin; Zhang, Yiping

    2014-01-01

    The preclinical experiments and several clinical studies showed icotinib, an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, in Chinese patients with advanced non-small cell lung cancer (NSCLC) who failed previous chemotherapy. We performed a retrospective study of the efficacy and safety of icotinib monotherapy in a different and more recent sample of Chinese patients. The clinical data of 149 patients with advanced NSCLC who were admitted to Zhejiang Cancer Hospital from August 1, 2011 to July 31, 2012 were retrospectively analyzed. All patients were given icotinib treatment after the failure of previous chemotherapy. Univariate and multivariate analyses were conducted based on the Kaplan Meier method and Cox proportional hazards model. The objective response rate was 33/149 and disease control rate was 105/149. No complete response occurred. Median progression free survival (PFS) with icotinib treatment was 5.03 months (95% CI: 3.51 to 6.55). Median overall survival was 12.3 months (95% CI: 10.68 to 13.92). Multivariate analysis showed that the mutation of EGFR and one regimen of prior chemotherapy were significantly associated with longer PFS. At least one drug related adverse event was observed in 65.8% (98/149) of patients, but mostly grade 1 or 2 and reversible and none grade 4 toxicity. Icotinib monotherapy is an effective and well tolerated regimen for Chinese patients with NSCLC after the failure of chemotherapy. It is a promising agent and further study with icotinib in properly conducted trials with larger patient samples and other ethnic groups is warranted.

  8. Risk factors for peritoneal dialysis catheter failure in children ...

    African Journals Online (AJOL)

    Background Peritoneal dialysis catheter (PDC) failure still remains a common clinical problem in pediatric patients despite advancements in catheter placement and dialysis techniques. Our aim was to determine the risk factors that may lead to PDC failure, especially those factors that could be potentially modified to ...

  9. Anemia in chronic heart failure : etiology and treatment options

    NARCIS (Netherlands)

    Westenbrink, B. Daan; de Boer, Rudolf A.; Voors, Adriaan A.; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    Purpose of review Anemia is common in patients with chronic heart failure, and is related to increased morbidity and mortality. The etiology of anemia in heart failure is complex and still not fully resolved. The review will describe current advances in the understanding of the pathophysiology of

  10. Age replacement policy based on imperfect repair with random probability

    International Nuclear Information System (INIS)

    Lim, J.H.; Qu, Jian; Zuo, Ming J.

    2016-01-01

    In most of literatures of age replacement policy, failures before planned replacement age can be either minimally repaired or perfectly repaired based on the types of failures, cost for repairs and so on. In this paper, we propose age replacement policy based on imperfect repair with random probability. The proposed policy incorporates the case that such intermittent failure can be either minimally repaired or perfectly repaired with random probabilities. The mathematical formulas of the expected cost rate per unit time are derived for both the infinite-horizon case and the one-replacement-cycle case. For each case, we show that the optimal replacement age exists and is finite. - Highlights: • We propose a new age replacement policy with random probability of perfect repair. • We develop the expected cost per unit time. • We discuss the optimal age for replacement minimizing the expected cost rate.

  11. Policy Learning and Organizational Capacities in Innovation Policies

    DEFF Research Database (Denmark)

    Borrás, Susana

    2011-01-01

    Bengt-Åke Lundvall’s work has underlined the importance of policy learning for inducing innovation systems’ adaptability. In spite of his efforts and of the general interest in this topic, studies of policy learning in innovation policy continue to be scarce. Elaborating from recent theoretical...... advances, the paper identifies three levels of policy learning and argues that their effects on innovation systems are related to specific capacities of the relevant organizations implementing change. This analytical framework is used in the study of trans-national policy learning in Europe in the area...... of science–industry relations, showing the importance of capacities (or lack thereof). This calls for the practical need of addressing organizational capacity-building, in particular of analytical capacity, for truly strategic innovation policy-making....

  12. Prognostic Estimation of Advanced Heart Failure With Low Left Ventricular Ejection Fraction and Wide QRS Interval.

    Science.gov (United States)

    Oh, Changmyung; Chang, Hyuk-Jae; Sung, Ji Min; Kim, Ji Ye; Yang, Wooin; Shim, Jiyoung; Kang, Seok-Min; Ha, Jongwon; Rim, Se-Joong; Chung, Namsik

    2012-10-01

    Cardiac resynchronization therapy (CRT) has been known to improve the outcome of advanced heart failure (HF) but is still underutilized in clinical practice. We investigated the prognosis of patients with advanced HF who were suitable for CRT but were treated with conventional strategies. We also developed a risk model to predict mortality to improve the facilitation of CRT. Patients with symptomatic HF with left ventricular ejection fraction ≤35% and QRS interval >120 ms were consecutively enrolled at cardiovascular hospital. After excluding those patients who had received device therapy, 239 patients (160 males, mean 67±11 years) were eventually recruited. During a follow-up of 308±236 days, 56 (23%) patients died. Prior stroke, heart rate >90 bpm, serum Na ≤135 mEq/L, and serum creatinine ≥1.5 mg/dL were identified as independent factors using Cox proportional hazards regression. Based on the risk model, points were assigned to each of the risk factors proportional to the regression coefficient, and patients were stratified into three risk groups: low- (0), intermediate-(1-5), and high-risk (>5 points). The 2-year mortality rates of each risk group were 5, 31, and 64 percent, respectively. The C statistic of the risk model was 0.78, and the model was validated in a cohort from a different institution where the C statistic was 0.80. The mortality of patients with advanced HF who were managed conventionally was effectively stratified using a risk model. It may be useful for clinicians to be more proactive about adopting CRT to improve patient prognosis.

  13. Pig models for the human heart failure syndrome

    DEFF Research Database (Denmark)

    Hunter, Ingrid; Terzic, Dijana; Zois, Nora Elisabeth

    2014-01-01

    Human heart failure remains a challenging illness despite advances in the diagnosis and treatment of heart failure patients. There is a need for further improvement of our understanding of the failing myocardium and its molecular deterioration. Porcine models provide an important research tool...... in this respect as molecular changes can be examined in detail, which is simply not feasible in human patients. However, the human heart failure syndrome is based on symptoms and signs, where pig models mostly mimic the myocardial damage, but without decisive data on clinical presentation and, therefore, a heart...... to elucidate the human heart failure syndrome....

  14. Nea study on the impact of advanced fuel cycles on waste management policies

    International Nuclear Information System (INIS)

    Cavedon, J.M.

    2007-01-01

    This study was carried out by the ad hoc Expert Group on the Impact of Advanced Fuel Cycles on Waste Management Policies convened under the auspices of the NEA Committee for Technical and Economic Studies on Nuclear Energy Development and the Fuel Cycle (NDC); the Integrated Group on Safety Case from the Radioactive Waste Management Committee provided support in the field of waste repository issues; the Nuclear Science Committee Working Group on Flowsheet Studies also provided some input data. The full report on this study is published as the NEA Report number 5990 - OECD 2006 by OECD Publications - ISBN 92-64-02296-1. The following text is extracted from the Executive Summary of the report. (author)

  15. Recent advances in treatment of heart failure [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Takeshi Kitai

    2015-12-01

    Full Text Available With the total cases and economic burden of heart failure continuing to rise, there is an overwhelming need for novel therapies. Several drugs for heart failure have succeeded in preclinical and early-phase clinical trials, but most of them failed to show the real benefit in pivotal clinical trials. Meanwhile, the US Food and Drug Administration recently approved two promising new drugs to treat heart failure: ivabradine and sacubitril/valsartan. Furthermore, some of the newer agents in testing offer the potential for significant progress in addition to these drugs. Patiromer and zirconium cyclosilicate are attractive agents that are expected to prevent hyperkalemia during renin-angiotensin-aldosterone system inhibition, and serelaxin and urodilatin are promising drugs in the treatment of acute heart failure. Future clinical trials with more appropriate study designs, optimal clinical endpoints, and proper patient selection are mandatory to assess the true efficacy of these attractive compounds in clinical practice.

  16. Formulating Public Policy in Croatia and the Problem of Policy Coordination

    Directory of Open Access Journals (Sweden)

    Zdravko Petak

    2008-01-01

    Full Text Available The paper explores the role of politicians and civil servants in the process of horizontal and vertical policy coordination, with a special emphasis on the specific context of Croatia. Starting from Guy Peters’ typology, which distinguishes four distinct types of coordination, ranging from more simple to more complex ones – negative coordination, positive coordination, policy integration and development of strategies for government, the author stresses that the Croatian case is connected with failure in achieving all types of coordination. One of the reasons for such a situation lies in a low level of applying classical policy analysis in the Croatian public administration system. A direct consequence of this is the existence of the system of coordination based on ad hoc assessment of proposed policies, and not on standard policy analysis tools. Therefore, in the lack of central government policy unit the prominent role in such a system belongs to the finance Minister, who serves as some kind of “policy switchman”.

  17. Policy in Transition. New Framework for Russia's Climate Policy

    International Nuclear Information System (INIS)

    Kotov, V.

    2002-07-01

    In 2000, Russia entered the second round of radical reforms of its economic and political system. These changes affect the institutions of the macro- and microeconomic policy, of the energy policy, as well as the institutions of the climate policy. Thus, the framework is currently being built in Russia within which the Climate Convention and the Kyoto Protocol are being and will be implemented. Success, or failure, in Russia's interactions with the international community in implementation of the UNFCCC and its Kyoto Protocol would depend, particularly, on whether it would be able to establish renovated climate policy institutions in the nearest future. Main provisions of the Kyoto Protocol open good perspectives for the climate policy of Russia. For these favourable perspectives to become a reality, Russia will have to accomplish quite a lot at the domestic, national level. Here, Russia is facing some serious problems. Among them are recently emerged problems with ratification of Kyoto Protocol

  18. Why is South Korea's renewable energy policy failing? A qualitative evaluation

    International Nuclear Information System (INIS)

    Yoon, Jong-Han; Sim, Kwang-ho

    2015-01-01

    This study explores the causes of the South Korean government's failure to successfully deploy its renewable energy policy. Despite the South Korean government’s ongoing efforts since 2002 to promote the deployment of renewable energy, the established deployment target has not been met and the share of renewable energy supply in total primary energy supply is poor compared to peer countries with a similar level of economic development. Therefore, we attempt to find the causes of this policy failure using qualitative evaluation methods. Through the analyses, conducted using focused interviews and secondary data, we found that the domination of the fossil fuel and nuclear power industry's interests, inconsistent policy shifts, policy design that lacks sufficient support schemes, poorly coordinated government activities, and unsystemic and untimely monitoring and feedback have led to the failure of renewable energy deployment policies in South Korea. To overcome these problems, we suggest that the South Korean government should set more ambitious policy goals, establish a new independent organization that focuses on energy policy issues, use a varied policy mix, and secure political support from diverse policy actors. - Highlights: • We identify factors for successful renewable energy deployment policies. • We construct an evaluation framework based on the established literature. • We analyze data collected from focused interviews and secondary materials. • There exists an overall weakness throughout all renewable energy policy phases. • We recommend some policy prescriptions based on the evaluation results.

  19. Patterns of failure following curative resection of gastric carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Landry, J.; Tepper, J.E.; Wood, W.C.; Moulton, E.O.; Koerner, F.; Sullinger, J. (Massachusetts General Hospital Cancer Center, Boston (USA))

    1990-12-01

    To identify patterns of failure following curative resection of gastric carcinoma, the records of 130 patients undergoing resection with curative intent at the Massachusetts General Hospital were reviewed. The total local-regional failure rate was 38% (49/130 patients), with 21 patients having local-regional failure alone and 28 patients having local-regional failure and distant metastases. The incidence of local failure rose with the more advanced stages of disease. Tumors staged B2, B3, C2, and C3 had local-regional failure rates in excess of 35%. This group of patients might benefit from adjuvant radiation therapy to the tumor bed and regional lymphatics. Local-regional failure rate was highest in the anastomosis or stump 33/130 (25%), followed by the stomach bed 27/130 (21%). The overall incidence of distant metastases was 52% (67/130 patients) and rose in the more advanced disease stages. Tumors staged B2, B3, C2, and C3 had rates of distant metastases greater than 50%. Sixty-one patients (77%) had failure in the abdomen (liver, peritoneal surface, adrenal, kidney, and spleen, but excluding tumor bed, anastomosis, or regional nodes). Patients with Stage B2, B3, C2, and C3 tumors had total abdominal failure rates greater than 40%. The highest failure rates in the liver were in Stages B3 and C3, in which the subsequent development of liver metastasis was 40% and 47%, respectively. Peritoneal seeding occurred in 30/130 (23%) of patients and was highest in Stages C2 and C3, with rates of 27% and 41%, respectively.

  20. Patterns of failure following curative resection of gastric carcinoma

    International Nuclear Information System (INIS)

    Landry, J.; Tepper, J.E.; Wood, W.C.; Moulton, E.O.; Koerner, F.; Sullinger, J.

    1990-01-01

    To identify patterns of failure following curative resection of gastric carcinoma, the records of 130 patients undergoing resection with curative intent at the Massachusetts General Hospital were reviewed. The total local-regional failure rate was 38% (49/130 patients), with 21 patients having local-regional failure alone and 28 patients having local-regional failure and distant metastases. The incidence of local failure rose with the more advanced stages of disease. Tumors staged B2, B3, C2, and C3 had local-regional failure rates in excess of 35%. This group of patients might benefit from adjuvant radiation therapy to the tumor bed and regional lymphatics. Local-regional failure rate was highest in the anastomosis or stump 33/130 (25%), followed by the stomach bed 27/130 (21%). The overall incidence of distant metastases was 52% (67/130 patients) and rose in the more advanced disease stages. Tumors staged B2, B3, C2, and C3 had rates of distant metastases greater than 50%. Sixty-one patients (77%) had failure in the abdomen (liver, peritoneal surface, adrenal, kidney, and spleen, but excluding tumor bed, anastomosis, or regional nodes). Patients with Stage B2, B3, C2, and C3 tumors had total abdominal failure rates greater than 40%. The highest failure rates in the liver were in Stages B3 and C3, in which the subsequent development of liver metastasis was 40% and 47%, respectively. Peritoneal seeding occurred in 30/130 (23%) of patients and was highest in Stages C2 and C3, with rates of 27% and 41%, respectively

  1. Evidence-based medicine and patient choice: the case of heart failure care.

    Science.gov (United States)

    Sanders, Tom; Harrison, Stephen; Checkland, Kath

    2008-04-01

    The implementation of evidence-based medicine and policies aimed at increasing user involvement in health care decisions are central planks of contemporary English health policy. Yet they are potentially in conflict. Our aim was to explore how clinicians working in the field of heart failure resolve this conflict. Qualitative semi-structured interviews were carried out with health professionals who were currently caring for patients with heart failure, and observations were conducted at one dedicated heart failure clinic in northern England. While clinicians acknowledged that patients' ideas and preferences should be an important part of treatment decisions, the widespread acceptance of an evidence-based clinical protocol for heart failure among the clinic doctors significantly influenced the content and style of the consultation. Evidence-based medicine was used to buttress professional authority and seemed to provide an additional barrier to the adoption of patient-centred clinical practice.

  2. Carbon Lock-Out: Advancing Renewable Energy Policy in Europe

    Directory of Open Access Journals (Sweden)

    Robert Pietzcker

    2012-02-01

    Full Text Available As part of its climate strategy, the EU aims at increasing the share of electricity from renewable energy sources (RES-E in overall electricity generation. Attaining this target poses a considerable challenge as the electricity sector is “locked” into a carbon-intensive system, which hampers the adoption of RES-E technologies. Electricity generation, transmission and distribution grids as well as storage and demand response are subject to important path dependences, which put existing, non-renewable energy sources at an advantage. This paper examines how an EU framework for RES-E support policies should be designed to facilitate a carbon lock-out. For this purpose, we specify the major technological, economic and institutional barriers to RES-E. For each of the barriers, a policy review is carried out which assesses the performance of existing policy instruments and identifies needs for reform. The review reveals several shortcomings: while policies targeting generation are widely in place, measures to address barriers associated with electricity grids, storage and demand are still in their infancy and have to be extended. Moreover, the implementation of policies has been fragmented across EU Member States. In this respect, national policies should be embedded into an integrated EU-wide planning of the RES-E system with overarching energy scenarios and partially harmonized policy rules.

  3. Focus on renal congestion in heart failure.

    Science.gov (United States)

    Afsar, Baris; Ortiz, Alberto; Covic, Adrian; Solak, Yalcin; Goldsmith, David; Kanbay, Mehmet

    2016-02-01

    Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are important prognostic factors in heart failure. Kidney congestion in heart failure results from low cardiac output (forward failure), tubuloglomerular feedback, increased intra-abdominal pressure or increased venous pressure. Regardless of the cause, renal congestion is associated with increased morbidity and mortality in heart failure. The impact on outcomes of renal decongestion strategies that do not compromise renal function should be explored in heart failure. These studies require novel diagnostic markers that identify early renal damage and renal congestion and allow monitoring of treatment responses in order to avoid severe worsening of renal function. In addition, there is an unmet need regarding evidence-based therapeutic management of renal congestion and worsening renal function. In the present review, we summarize the mechanisms, diagnosis, outcomes, prognostic markers and treatment options of renal congestion in heart failure.

  4. Fuel failure detection in operating reactors

    International Nuclear Information System (INIS)

    Seigel, B.; Hagen, H.H.

    1977-12-01

    Activity detectors in commercial BWRs and PWRs are examined to determine their capability to detect a small number of fuel rod failures during reactor operation. The off-gas system radiation monitor in a BWR and the letdown line radiation monitor in a PWR are calculated to have this capability, and events are cited that support this analysis. Other common detectors are found to be insensitive to small numbers of fuel failures. While adequate detectors exist for normal and transient operation, those detectors would not perform rapidly enough to be useful during accidents; in most accidents, however, primary system sensors (pressure, temperature, level) would provide adequate warning. Advanced methods of fuel failure detection are mentioned

  5. Replacement and inspection policies for products with random life cycle

    International Nuclear Information System (INIS)

    Yun, Won Young; Nakagawa, Toshio

    2010-01-01

    In this paper, we consider maintenance policies for products in which the economical life cycle of products is a random variable. First, we study a periodic replacement policy with minimal repair. The system is minimally repaired at failure and is replaced by new one at age T (periodic replacement policy with minimal repair of Barlow and Hunter). The expected present value of total maintenance cost of products with random life cycle is obtained and the optimal replacement interval minimizing the cost is found. Second, we consider an inspection policy for products with random life cycle to detect the system failure. The expected total cost is obtained and the optimal inspection interval is found. Numerical examples are also included.

  6. US National Trends in Mortality From Acute Myocardial Infarction and Heart Failure: Policy Success or Failure?

    Science.gov (United States)

    Chatterjee, Paula; Joynt Maddox, Karen E

    2018-03-14

    Hospitals in the United States have been subject to mandatory public reporting of mortality rates for acute myocardial infarction (AMI) and heart failure (HF) since 2007 and to value-based payment programs for these conditions since 2011. However, whether hospitals with initially poor baseline performance have improved relative to other hospitals under these programs, and whether patterns of improvement differ by condition, is unknown. Understanding trends within public reporting and value-based payment can inform future efforts in these areas. To examine patterns in 30-day mortality from AMI and HF and determine whether they differ for baseline poor performers (worst quartile in 2009 and 2010 in public reporting, prior to value-based payment) compared with other hospitals. Retrospective cross-sectional study at US acute care hospitals from 2009 to 2015 that included 2751 and 3796 hospitals with publicly reported mortality data for AMI and HF, respectively. Public reporting and value-based purchasing. Hospital-level risk-adjusted 30-day mortality rates. We identified 422 and 600 baseline poor-performing hospitals for AMI and HF, respectively. Baseline poor performers for AMI were more often public and for-profit and less often teaching hospitals. Baseline poor performers for HF were less often large hospitals. For AMI, 30-day mortality among baseline poor performers was higher at baseline but improved more over time compared with other hospitals (18.6% in 2009 to 14.6% in 2015; -0.74% per year; P < .001 vs 15.7% in 2009 to 14.0% in 2015; -0.26% per year; P < .001; P for interaction <.001). In contrast, for HF, baseline poor performers improved over time (13.5%-13.0%; -0.12% per year; P < .001), but mean mortality among all other HF hospitals increased during the study period (10.9%-12.0%; 0.17% per year; P < .001; P for interaction, <.001). Despite being subject to identical policy pressures, mortality trends for AMI and HF differed markedly between

  7. Mechanical Circulatory Support for Advanced Heart Failure: Are We about to Witness a New “Gold Standard”?

    Directory of Open Access Journals (Sweden)

    Massimo Capoccia

    2016-12-01

    Full Text Available The impact of left ventricular assist devices (LVADs for the treatment of advanced heart failure has played a significant role as a bridge to transplant and more recently as a long-term solution for non-eligible candidates. Continuous flow left ventricular assist devices (CF-LVADs, based on axial and centrifugal design, are currently the most popular devices in view of their smaller size, increased reliability and higher durability compared to pulsatile flow left ventricular assist devices (PF-LVADs. The trend towards their use is increasing. Therefore, it has become mandatory to understand the physics and the mathematics behind their mode of operation for appropriate device selection and simulation set up. For this purpose, this review covers some of these aspects. Although very successful and technologically advanced, they have been associated with complications such as pump thrombosis, haemolysis, aortic regurgitation, gastro-intestinal bleeding and arterio-venous malformations. There is perception that the reduced arterial pulsatility may be responsible for these complications. A flow modulation control approach is currently being investigated in order to generate pulsatility in rotary blood pumps. Thrombus formation remains the most feared complication that can affect clinical outcome. The development of a preoperative strategy aimed at the reduction of complications and patient-device suitability may be appropriate. Patient-specific modelling based on 3D reconstruction from CT-scan combined with computational fluid dynamic studies is an attractive solution in order to identify potential areas of stagnation or challenging anatomy that could be addressed to achieve the desired outcome. The HeartMate II (axial and the HeartWare HVAD (centrifugal rotary blood pumps have been now used worldwide with proven outcome. The HeartMate III (centrifugal is now emerging as the new promising device with encouraging preliminary results. There are now

  8. Failure is an option: Reactions to failure in elementary engineering design projects

    Science.gov (United States)

    Johnson, Matthew M.

    Recent reform documents in science education have called for teachers to use epistemic practices of science and engineering researchers to teach disciplinary content (NRC, 2007; NRC, 2012; NGSS Lead States, 2013). Although this creates challenges for classroom teachers unfamiliar with engineering, it has created a need for high quality research about how students and teachers engage in engineering activities to improve curriculum development and teaching pedagogy. While framers of the Next Generation Science Standards (NRC, 2012; NGSS Lead States 2013) focused on the similarities of the practices of science researchers and engineering designers, some have proposed that engineering has a unique set of epistemic practices, including improving from failure (Cunningham & Carlsen, 2014; Cunningham & Kelly, in review). While no one will deny failures occur in science, failure in engineering is thought of in fundamentally different ways. In the study presented here, video data from eight classes of elementary students engaged in one of two civil engineering units were analyzed using methods borrowed from psychology, anthropology, and sociolinguistics to investigate: 1) the nature of failure in elementary engineering design; 2) the ways in which teachers react to failure; and 3) how the collective actions of students and teachers support or constrain improvement in engineering design. I propose new ways of considering the types and causes of failure, and note three teacher reactions to failure: the manager, the cheerleader, and the strategic partner. Because the goal of iteration in engineering is improvement, I also studied improvement. Students only systematically improve when they have the opportunity, productive strategies, and fair comparisons between prototypes. I then investigate the use of student engineering journals to assess learning from the process of improvement after failure. After discussion, I consider implications from this work as well as future research

  9. Major Environmental Policy in 2000

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hong Jin [Ministry Of Environment, Kwachon (Korea)

    2000-04-01

    As a new millennium has started, there are active movements developing a basic paradigm of vision and policy over a nation-wide to prepare changes actively. For the environmental sector, it is possible to live in a pleasant environment if everyone prepare and work together like dealing with Y2K problem. With a goal of being an environmentally advanced country in the early new millennium, it is planned to improve a basic life environment such as water and air and to promote an advanced environmental management policy for showing results of its reform in 2000. Therefore, it examines environmental management circumstances and a direction of environmental policy first and it discusses more about major environmental policy related to petroleum industry. 7 tabs.

  10. Optimal advanced credit releases in ecosystem service markets.

    Science.gov (United States)

    BenDor, Todd K; Guo, Tianshu; Yates, Andrew J

    2014-03-01

    Ecosystem service markets are popular policy tools for ecosystem protection. Advanced credit releases are an important factor affecting the supply side of ecosystem markets. Under an advanced credit release policy, regulators give ecosystem suppliers a fraction of the total ecosystem credits generated by a restoration project before it is verified that the project actually achieves the required ecological thresholds. In spite of their prominent role in ecosystem markets, there is virtually no regulatory or research literature on the proper design of advanced credit release policies. Using U.S. aquatic ecosystem markets as an example, we develop a principal-agent model of the behavior of regulators and wetland/stream mitigation bankers to determine and explore the optimal degree of advance credit release. The model highlights the tension between regulators' desire to induce market participation, while at the same time ensuring that bankers successfully complete ecological restoration. Our findings suggest several simple guidelines for strengthening advanced credit release policy.

  11. When Regional Innovation Policies Meet Policy Rationales and Evidence:

    DEFF Research Database (Denmark)

    Borrás, Susana; Jordana, Jacint

    regions, and to understand how rationales and evidence can be translated into policy-making. To this purpose, this paper develops a framework to study the extent to which regional innovation policies have changed during the past few years. Since the mid-2000s there has been an important development......In spite of recent advancements regarding regional innovation policy rationales and evidence, there are few analyses about the actual features of existing regional innovation policies. Nevertheless, a policy analysis perspective is important in order to recognise their distinctive patterns across...... of innovation policy rationales, advocating for more specialisation; likewise, greater data availability at the regional level has allowed more sophisticated assessment of innovation performance. Finally, the crisis since 2008 has had ravaging effects in some regions, with job losses and severe economic...

  12. When Regional Innovation Policies Meet Policy Rationales and Evidence

    DEFF Research Database (Denmark)

    Borrás, Susana; Jordana, Jacint

    2016-01-01

    regions, and to understand how rationales and evidence can be translated into policy-making. To this purpose, this paper develops a framework to study the extent to which regional innovation policies have changed during the past few years. Since the mid-2000s, there has been an important development......In spite of recent advancements regarding regional innovation policy rationales and evidence, there are few analyses about the actual features of existing regional innovation policies. Nevertheless, a policy analysis perspective is important in order to recognize their distinctive patterns across...... of innovation policy rationales, advocating for more specialization; likewise, greater data availability at the regional level has allowed more sophisticated assessment of innovation performance. Finally, the crisis since 2008 has had ravaging effects in some regions, with job losses and severe economic...

  13. 48 CFR 970.3200 - Policy.

    Science.gov (United States)

    2010-10-01

    ... DOE MANAGEMENT AND OPERATING CONTRACTS Contract Financing 970.3200 Policy. It is the policy of the Department of Energy (DOE) to finance management and operating contracts through advance payments and the use...

  14. Detection of Failure in Asynchronous Motor Using Soft Computing Method

    Science.gov (United States)

    Vinoth Kumar, K.; Sony, Kevin; Achenkunju John, Alan; Kuriakose, Anto; John, Ano P.

    2018-04-01

    This paper investigates the stator short winding failure of asynchronous motor also their effects on motor current spectrums. A fuzzy logic approach i.e., model based technique possibly will help to detect the asynchronous motor failure. Actually, fuzzy logic similar to humanoid intelligent methods besides expected linguistic empowering inferences through vague statistics. The dynamic model is technologically advanced for asynchronous motor by means of fuzzy logic classifier towards investigate the stator inter turn failure in addition open phase failure. A hardware implementation was carried out with LabVIEW for the online-monitoring of faults.

  15. When things go wrong: how health care organizations deal with major failures.

    Science.gov (United States)

    Walshe, Kieran; Shortell, Stephen M

    2004-01-01

    Concern about patient safety, caused in part by high-profile major failures in which many patients have been harmed, is rising worldwide. This paper draws on examples of such failures from several countries to analyze how these events are dealt with and to identify lessons and recommendations for policy. Better systems are needed for reporting and investigating failures and for implementing the lessons learned. The culture of secrecy, professional protectionism, defensiveness, and deference to authority is central to such major failures, and preventing future failures depends on cultural as much as structural change in health care systems and organizations.

  16. Chief nursing officers’ perspectives on Medicare’s hospital-acquired conditions non-payment policy: implications for policy design and implementation

    Directory of Open Access Journals (Sweden)

    Wald Heidi

    2012-08-01

    Full Text Available Abstract Background Preventable adverse events from hospital care are a common patient safety problem, often resulting in medical complications and additional costs. In 2008, Center for Medicare and Medicaid Services (CMS implemented a policy, mandated by the Deficit Reduction Act of 2005, targeting a list of these ‘reasonably’ preventable hospital-acquired conditions (HACs for reduced reimbursement. Extensive debate ensued about the potential adverse effects of the policy, but there was little discussion of its impact on hospitals’ quality improvement (QI activities. This study’s goals were to understand organizational responses to the HAC policy, including internal and external influences that moderated the success or failure of QI efforts. Methods We employed a qualitative descriptive design. Representatives from 14 Nurses Improving Care of Health System Elders (NICHE hospitals participated in semi-structured interviews addressing the impact of the HAC policy generally, and for two indicator conditions: central-line associated bloodstream infection (CLABSI and catheter-associated urinary tract infection (CAUTI. Within-case analysis identified the key components of each institution’s response to the policy; across-case analysis identified themes. Exemplar cases were used to explicate findings. Results Interviewees reported that the HAC policy is one of many internal and external factors motivating hospitals to address HACs. They agreed the policy focused attention on prevention of HACs that had previously received fewer dedicated resources. The impact of the policy on prevention activities, barriers, and facilitators was condition-specific. CLABSI efforts were in place prior to the policy, whereas CAUTI efforts were less mature. Nearly all respondents noted that pressure ulcer detection and documentation became a larger focus stemming from the policy change. A major challenge was the determination of which conditions were

  17. Advances on the Failure Analysis of the Dam—Foundation Interface of Concrete Dams

    Directory of Open Access Journals (Sweden)

    Luis Altarejos-García

    2015-12-01

    Full Text Available Failure analysis of the dam-foundation interface in concrete dams is characterized by complexity, uncertainties on models and parameters, and a strong non-linear softening behavior. In practice, these uncertainties are dealt with a well-structured mixture of experience, best practices and prudent, conservative design approaches based on the safety factor concept. Yet, a sound, deep knowledge of some aspects of this failure mode remain unveiled, as they have been offset in practical applications by the use of this conservative approach. In this paper we show a strategy to analyse this failure mode under a reliability-based approach. The proposed methodology of analysis integrates epistemic uncertainty on spatial variability of strength parameters and data from dam monitoring. The purpose is to produce meaningful and useful information regarding the probability of occurrence of this failure mode that can be incorporated in risk-informed dam safety reviews. In addition, relationships between probability of failure and factors of safety are obtained. This research is supported by a more than a decade of intensive professional practice on real world cases and its final purpose is to bring some clarity, guidance and to contribute to the improvement of current knowledge and best practices on such an important dam safety concern.

  18. Failure analysis and failure prevention in electric power systems

    International Nuclear Information System (INIS)

    Rau, C.A. Jr.; Becker, D.G.; Besuner, P.M.; Cipolla, R.C.; Egan, G.R.; Gupta, P.; Johnson, D.P.; Omry, U.; Tetelman, A.S.; Rettig, T.W.; Peters, D.C.

    1977-01-01

    New methods have been developed and applied to better quantify and increase the reliability, safety, and availability of electric power plants. Present and potential problem areas have been identified both by development of an improved computerized data base of malfunctions in nuclear power plants and by detailed metallurgical and mechanical failure analyses of selected problems. Significant advances in the accuracy and speed of structural analyses have been made through development and application of the boundary integral equation and influence function methods of stress and fracture mechanics analyses. The currently specified flaw evaluation procedures of the ASME Boiler and Pressure Vessel Code have been computerized. Results obtained from these procedures for evaluation of specific in-service inspection indications have been compared with results obtained utilizing the improved analytical methods. Mathematical methods have also been developed to describe and analyze the statistical variations in materials properties and in component loading, and uncertainties in the flaw size that might be passed by quality assurance systems. These new methods have been combined to develop accurate failure rate predictions based upon probabilistic fracture mechanics. Improved failure prevention strategies have been formulated by combining probabilistic fracture mechanics and cost optimization techniques. The approach has been demonstrated by optimizing the nondestructive inspection level with regard to both reliability and cost. (Auth.)

  19. Why Do Electricity Policy and Competitive Markets Fail to Use Advanced PV Systems to Improve Distribution Power Quality?

    Directory of Open Access Journals (Sweden)

    Mark P. McHenry

    2016-01-01

    Full Text Available The increasing pressure for network operators to meet distribution network power quality standards with increasing peak loads, renewable energy targets, and advances in automated distributed power electronics and communications is forcing policy-makers to understand new means to distribute costs and benefits within electricity markets. Discussions surrounding how distributed generation (DG exhibits active voltage regulation and power factor/reactive power control and other power quality capabilities are complicated by uncertainties of baseline local distribution network power quality and to whom and how costs and benefits of improved electricity infrastructure will be allocated. DG providing ancillary services that dynamically respond to the network characteristics could lead to major network improvements. With proper market structures renewable energy systems could greatly improve power quality on distribution systems with nearly no additional cost to the grid operators. Renewable DG does have variability challenges, though this issue can be overcome with energy storage, forecasting, and advanced inverter functionality. This paper presents real data from a large-scale grid-connected PV array with large-scale storage and explores effective mitigation measures for PV system variability. We discuss useful inverter technical knowledge for policy-makers to mitigate ongoing inflation of electricity network tariff components by new DG interconnection requirements or electricity markets which value power quality and control.

  20. Can failure carefully observed become a springboard to success?

    Science.gov (United States)

    Adrian, Manuella

    2012-01-01

    Since its inception, the addictions field has had a history of failure: failures in conceptualizations, in treatment, in interventions, in policies, in process as well as outcome assessment. Certain actions and activities have had a less than stellar effect which may lead to feelings of personal failure among practitioners, the tagging of processes and programs as being failures when they are not so, as well as an identification of the person being intervened with, by self and others, as being a failure or loser. This paper discusses how to define success and failure and the need to identify both the short(er) and long(er) term, as well as temporary and permanent effects, including the implications of using binary (success or failure; success and failure) and nonbinary (and in addition) categories of assessment. The need to clarify expectations and to establish goals and measurable effects are noted. Being open to accepting results which may be personally disappointing, initially, but which offer opportunities for needed changes may lead to new developments in the field and the establishment of better interventions.

  1. Assessment of the effectiveness of European air quality policies and measures. Final report on Task 3.3. Survey to access successes and failures of the EU Air Quality Policies

    International Nuclear Information System (INIS)

    2004-01-01

    The main objective of Task 3.3 of the title project was to survey the views of European policy makers and other stakeholders directly involved in air quality policy development and implementation on the successes and failures of the present European air quality policies. The survey also included several decisionmakers from the USA, Japan and Switzerland to learn about these countries' experiences with specific air quality policies. A list of approximately 90 people to be surveyed during the project was developed. The list included representatives from the European Commission, the European Parliament, national-level representatives from the Member States, including those designated by the CAFE Steering Group, along with representatives of local authorities, NGOs, industry and academia. The survey was conducted through a questionnaire and follow-up interviews. The questionnaire consists of four major parts. Part 1 includes questions about the impact of EU legislation on air quality. Part 2 is designed to learn about stakeholder opinions on the adequacy of Community-level measures with respect to air quality protection. Part 3 asks for opinions about various measures used in Community-level legislation on air quality as well as ideas for new or modified measures that could be effective in achieving better air quality in the EU. Part 4 includes questions about stakeholder involvement and transparency and was designed to assist with the implementation of Task 3.4 (on public participation and transparency) of the project. The analysis of responses for this part of the questionnaire is presented in the parallel Report for Task 3.4. The final version of the questionnaire used to interview European stakeholders is attached as Appendix II. For the decision-makers from the USA, Switzerland, and Japan a separate questionnaire was developed, and is attached as Appendix III. In all, the team received 49 responses from the 90 enquiries.

  2. ASSESSING FEED-IN-TARIFF POLICY APPROACHES FOR AN ACTIVE PROMOTION OF RENEWABLE POWER. COMPARATIVE ANALYSIS FOR WIND AND PV TECHNOLOGIES

    Directory of Open Access Journals (Sweden)

    IRINA NASALCIUC

    2016-10-01

    Full Text Available The consequence of business-as-usual frameworks (BAU has occasioned the market failures of modern economies inclusively of energy markets which shifted from BAU models to low carbon economies. Periodic paradigm shifts operating on energy markets drive impressive market transitions aiming to perform higher innovative approaches over the composite energy generation portfolios thus providing advanced managerial mechanisms for renewable energy sources-electricity (RES-E strategic deployment inclusively. In this context it appeared imperious to develop smart policies and patterns of promoting renewables beyond and stimulate a fast transition to smart grids. The current paper aims to better address the policy risks and to extend the relevance of policy learning process involved in the course of boosting up a whole industry system. The study reveals an updated overlook on the feed-in-tariff policies operating on green markets, identifies their regulatory risks and offers a new sight over the interconnection Investment- Regulatory Policy- Economic efficiency in targeting new investments of RES-E, focusing on a case study assessment.

  3. Free Markets, Property Rights and Climate Change: How to Privatize Climate Policy

    Directory of Open Access Journals (Sweden)

    Graham Dawson

    2011-04-01

    Full Text Available The goal has been to devise a strategy that protects as much as possible the rights and liberties of all agents, both users of fossil fuels and people whose livelihoods and territories are at risk if the anthropogenic global warming (AGW hypothesis is true. To achieve this goal the standard climate policy instruments, taxes and emissions trading, should be discontinued. There are weaknesses in the theoretical perspectives used to justify these policy instruments and climate science cannot provide the knowledge that would be needed to justify their implementation. In their place I propose a privatised policy, based on Austrian and libertarian frameworks of thought, which share an interpretation of climate change as a putative interpersonal conflict rather than market failure. The use of fossil fuels, like any other economic activity, should be subject to side-constraints designed to avoid the infringement of other people’s property rights. Tort litigation on the basis of strict liability would protect these rights, insofar as they need protecting. By providing a public arena for the competitive testing of scientific hypotheses concerning climate change, such litigation would also promote the public understanding and even the advancement of climate science.

  4. Green electricity policy in the Netherlands. An analysis of policy decisions

    International Nuclear Information System (INIS)

    Rooijen, Sascha van; Wees, Mark van

    2003-01-01

    Over the last decades, fundamental changes in both market conditions and the national and international policy framework in the Netherlands can be observed. The Dutch Government has intervened in markets regularly, demonstrating fundamental shifts in policy and approach. This study aims to analyse the developments in renewable energy policy making in the Netherlands. It assesses changes in the choice of policy instruments and target groups, the role of stakeholders and offers explanations behind policy successes and failures. The following conclusions can be drawn on the policy choices: First, the objectives and targets of Dutch renewable energy policy were frequently ambiguous. Although the government emphasised the importance of investments in local capacity, imports were always (implicitly) seen as an alternative option in meeting targets. Second, for a long period the government focused on reducing investment costs and dismantling administrative barriers. Only recently has the lack of a stable investment climate been identified as a potential barrier. Third, although many stakeholders have advocated a mandatory approach, Dutch policies stimulating renewable energy have always been voluntary. Finally, the Ministry of Economic Affairs has always played a very dominant role in renewable energy policy formulation and implementation, which may explain the fact that some unfavourable market reactions to policies have not been foreseen. (author)

  5. Patterns of failure after induction chemotherapy and radiotherapy for locoregionally advanced nasopharyngeal carcinoma: the Queen Mary Hospital experience

    International Nuclear Information System (INIS)

    Chua, Daniel T.T.; Sham, Jonathan S.T.; Choy, Damon; Kwong, Dora L.W.; Au, Gordon K.H.; Kwong, Philip W.K.; Yau, C.-C.; Cheng, Ashley C.K.; Wan, K.Y.

    2001-01-01

    Purpose: Our center contributed 183 patients to the Asian-Oceanian Clinical Oncology Association (AOCOA) multicenter randomized trial comparing induction chemotherapy (CT) followed by radiotherapy (RT) vs. RT alone in patients with locoregionally advanced undifferentiated nasopharyngeal carcinoma (NPC). In a preliminary report no difference in terms of overall survival or relapse-free survival was found between the 2 treatment arms. To study the long-term outcome and patterns of failure after CT for NPC, we analyzed our own center data for which a uniform radiation treatment protocol was adopted and a longer follow-up time was available. Methods and Materials: Between September 1989 and August 1993, a total of 183 patients were recruited into the AOCOA randomized study from our center. Patients with newly diagnosed NPC of Ho's T3 disease, N2-N3 disease, or with neck node size of at least 3 cm were eligible. Stratification was made according to the nodal size (≤3 cm, >3-6 cm, > 6 cm). Patients were randomized to receive 2-3 cycles of CT with cisplatin 60 mg/m 2 and epirubicin 110 mg/m 2 D1 followed by RT or RT alone. Four patients were excluded from the current analysis (2 died before treatment, 2 received treatment elsewhere). The remaining 179 patients were randomized to the two treatment arms, with 92 to the CT arm and 87 to the RT arm. Two patients in the CT arm had RT only, and all patients completed radiation treatment. Overall survival (OAS), relapse-free survival (RFS), local relapse-free survival (LRFS), nodal relapse-free survival (NRFS), and distant metastases-free survival (DMFS) were analyzed using Kaplan-Meier method and significance of survival curve differences calculated using log-rank test. Analysis was performed based on the intent-to-treat. Results: The median follow-up was 70 months. At the time of analysis, 50% of patients in the CT arm and 61% in the RT arm had relapse, while 32% in the CT arm and 36% in the RT arm had died of the disease

  6. Discerning and Addressing Environmental Failures in Policy Scenarios Using Planning Support System (PSS Technologies

    Directory of Open Access Journals (Sweden)

    Brian Deal

    2016-12-01

    Full Text Available The environmental consequences of planning decisions are often undervalued. This can result from a number of potential causes: (a there might be a lack of adequate information to correctly assess environmental consequences; (b stakeholders might discount the spatial and temporal impacts; (c a failure to understand the dynamic interactions between socio-ecological systems including secondary and tertiary response mechanisms; or (d the gravity of the status quo, i.e., blindly following a traditional discourse. In this paper, we argue that a Planning Support System (PSS that enhances an assessment of environmental impacts and is integral to a community or regional planning process can help reveal the true environmental implications of scenario planning decisions, and thus improve communal planning and decision-making. We demonstrate our ideas through our experiences developing and deploying one such PSS—the Land-use Evolution and impact Assessment Model (LEAM Planning Support System. University of Illinois researchers have worked directly with government planning officials and community stakeholders to analyze alternate future development scenarios and improve the planning process through a participatory, iterative process of visioning, model tuning, simulation, and discussion. The resulting information enables an evaluation of alternative policy or investment choices and their potential environmental implications that can change the way communities both generate and use plans.

  7. On Health Policy and Management (HPAM: Mind the Theory-Policy-Practice Gap

    Directory of Open Access Journals (Sweden)

    David Chinitz

    2014-12-01

    Full Text Available We argue that the field of Health Policy and Management (HPAM ought to confront the gap between theory, policy, and practice. Although there are perennial efforts to reform healthcare systems, the conceptual barriers are considerable and reflect the theory-policy-practice gap. We highlight four dimensions of the gap: 1 the dominance of microeconomic thinking in health policy analysis and design; 2 the lack of learning from management theory and comparative case studies; 3 the separation of HPAM from the rank and file of healthcare; and 4 the failure to expose medical students to issues of HPAM. We conclude with suggestions for rethinking the field of HPAM by embracing broader perspectives, e.g. ethics, urban health, systems analysis and cross-national analyses of healthcare systems.

  8. Environmental policy and environment-saving technologies. Economic aspects of policy making under uncertainty

    Energy Technology Data Exchange (ETDEWEB)

    Ossokina, I.

    2003-07-01

    It is generally known that natural environment is profoundly influenced by technological change. The direction and the size of this influence are, however, surrounded by uncertainties, which substantially complicate environmental policy making. This dissertation uses game-theoretical models to study policy making under uncertainty about (a) the costs of technological advances in pollution control, (b) the preferences of the policy maker and the voters, and (c) the consequences of policy measures. From a positive point of view the analysis provides explanations for environmental policies in modern democracies. From a normative point of view it gives a number of recommendations to improve environmental policies.

  9. Heart Failure as an Aging-Related Phenotype.

    Science.gov (United States)

    Morita, Hiroyuki; Komuro, Issei

    2018-01-27

    The molecular pathophysiology of heart failure, which is one of the leading causes of mortality, is not yet fully understood. Heart failure can be regarded as a systemic syndrome of aging-related phenotypes. Wnt/β-catenin signaling and the p53 pathway, both of which are key regulators of aging, have been demonstrated to play a critical role in the pathogenesis of heart failure. Circulating C1q was identified as a novel activator of Wnt/β-catenin signaling, promoting systemic aging-related phenotypes including sarcopenia and heart failure. On the other hand, p53 induces the apoptosis of cardiomyocytes in the failing heart. In these molecular mechanisms, the cross-talk between cardiomyocytes and non-cardiomyocytes (e,g,. endothelial cells, fibroblasts, smooth muscle cells, macrophages) deserves mentioning. In this review, we summarize recent advances in the understanding of the molecular pathophysiology underlying heart failure, focusing on Wnt/β-catenin signaling and the p53 pathway.

  10. AdvanceVT Work/Life Policies : Summary Report

    OpenAIRE

    AdvanceVT

    2010-01-01

    AdvanceVT’s 2008 Faculty Work/Life Survey showed that 59% of tenured and tenure-track faculty members at Virginia Tech believe it is difficult to have a personal life and earn tenure and 48% feel that their family responsibilities have slowed their career advancement. Female faculty members indicated that they have considered leaving the university in order to obtain better career opportunities for their spouse or partner (43%), as well as to achieve a better personal/professional balance (50...

  11. Advanced light source vacuum policy and vacuum guidelines for beamlines and experiment endstations

    International Nuclear Information System (INIS)

    Hussain, Z.

    1995-08-01

    The purpose of this document is to: (1) Explain the ALS vacuum policy and specifications for beamlines and experiment endstations. (2) Provide guidelines related to ALS vacuum policy to assist in designing beamlines which are in accordance with ALS vacuum policy. This document supersedes LSBL-116. The Advanced Light Source is a third generation synchrotron radiation source whose beam lifetime depends on the quality of the vacuum in the storage ring and the connecting beamlines. The storage ring and most of the beamlines share a common vacuum and are operated under ultra-high-vacuum (UHV) conditions. All endstations and beamline equipment must be operated so as to avoid contamination of beamline components, and must include proper safeguards to protect the storage ring vacuum from an accidental break in the beamline or endstation vacuum systems. The primary gas load during operation is due to thermal desorption and electron/photon induced desorption of contaminants from the interior of the vacuum vessel and its components. The desorption rates are considerably higher for hydrocarbon contamination, thus considerable emphasis is placed on eliminating these sources of contaminants. All vacuum components in a beamline and endstation must meet the ALS vacuum specifications. The vacuum design of both beamlines and endstations must be approved by the ALS Beamline Review Committee (BRC) before vacuum connections to the storage ring are made. The vacuum design is first checked during the Beamline Design Review (BDR) held before construction of the beamline equipment begins. Any deviation from the ALS vacuum specifications must be approved by the BRC prior to installation of the equipment on the ALS floor. Any modification that is incorporated into a vacuum assembly without the written approval of the BRC is done at the user's risk and may lead to rejection of the whole assembly

  12. Opportunity-based age replacement policy with minimal repair

    International Nuclear Information System (INIS)

    Jhang, J.P.; Sheu, S.H.

    1999-01-01

    This paper proposes an opportunity-based age replacement policy with minimal repair. The system has two types of failures. Type I failures (minor failures) are removed by minimal repairs, whereas type II failures are removed by replacements. Type I and type II failures are age-dependent. A system is replaced at type II failure (catastrophic failure) or at the opportunity after age T, whichever occurs first. The cost of the minimal repair of the system at age z depends on the random part C(z) and the deterministic part c(z). The opportunity arises according to a Poisson process, independent of failures of the component. The expected cost rate is obtained. The optimal T * which would minimize the cost rate is discussed. Various special cases are considered. Finally, a numerical example is given

  13. Use of angiotensin receptor – neprilysin inhibitors in heart failure: a ...

    African Journals Online (AJOL)

    Heart failure is a clinical syndrome responsible for at least one-third of hospitalisations amongst cardiac patients, with escalating mortality and healthcare costs on both public and private health care. Both prevalence and incidence of heart failure increase steeply with advancing age, making it a growing public health ...

  14. Lung Cancer Workshop XI: Tobacco-Induced Disease: Advances in Policy, Early Detection and Management.

    Science.gov (United States)

    Mulshine, James L; Avila, Rick; Yankelevitz, David; Baer, Thomas M; Estépar, Raul San Jose; Ambrose, Laurie Fenton; Aldigé, Carolyn R

    2015-05-01

    The Prevent Cancer Foundation Lung Cancer Workshop XI: Tobacco-Induced Disease: Advances in Policy, Early Detection and Management was held in New York, NY on May 16 and 17, 2014. The two goals of the Workshop were to define strategies to drive innovation in precompetitive quantitative research on the use of imaging to assess new therapies for management of early lung cancer and to discuss a process to implement a national program to provide high quality computed tomography imaging for lung cancer and other tobacco-induced disease. With the central importance of computed tomography imaging for both early detection and volumetric lung cancer assessment, strategic issues around the development of imaging and ensuring its quality are critical to ensure continued progress against this most lethal cancer.

  15. Pathways to Advancing Aging Policy-Relevant Research in Academic Settings.

    Science.gov (United States)

    Kietzman, Kathryn G; Troy, Lisa M; Green, Carmen R; Wallace, Steven P

    2016-01-01

    Policy-level changes have a significant influence on the health and well-being of aging populations. Yet there is often a gap between scientific knowledge and policy action. Although previous research has identified barriers and facilitators to effective knowledge translation, little attention has been given to the role of academic institutions in knowledge generation. This exploratory focus group study examines barriers and pathways to developing and maintaining an aging policy-relevant research agenda in academic settings, and additional challenges associated with minority group membership in this pursuit. Participants were personally committed to conducting policy-relevant research despite institutional barriers such as fewer funding opportunities and less value attributed to their research, particularly in the context of tenure and promotion. Although many viewed their research as an opportunity to make a difference, especially for underserved older adult populations, a number of minority group participants expressed that their policy research interests were marginalized. Participants offer individual and institutional-level strategies for addressing barriers, including collaborating with community members and colleagues and engaging mentors within and outside of their academic institutions. Reframing the valuation of policy research through the diversification of funding and publishing opportunities can better support scholars engaged in aging policy-relevant research.

  16. Relationship of right- to left-sided ventricular filling pressures in advanced heart failure: insights from the ESCAPE trial.

    Science.gov (United States)

    Drazner, Mark H; Velez-Martinez, Mariella; Ayers, Colby R; Reimold, Sharon C; Thibodeau, Jennifer T; Mishkin, Joseph D; Mammen, Pradeep P A; Markham, David W; Patel, Chetan B

    2013-03-01

    Although right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) are correlated in heart failure, in a sizeable minority of patients, the RAP and PCWP are not tightly coupled. The basis of this variability in the RAP/PCWP ratio, and whether it conveys prognostic value, is not known. We analyzed the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial database. Baseline characteristics, including echocardiographic assessment of right ventricular (RV) structure and function, and invasively measured hemodynamic parameters, were compared among tertiles of the RAP/PCWP ratio. Multivariable Cox proportional hazard models assessed the association of RAP/PCWP ratio with the primary ESCAPE outcome (6-month death or hospitalization [days]) adjusting for systolic blood pressure, blood urea nitrogen, 6-minute walk distance, and PCWP. The RAP/PCWP tertiles were 0.27 to 0.4 (tertile 1); 0.41 to 0.615 (tertile 2), and 0.62 to 1.21 (tertile 3). Increasing RAP/PCWP was associated with increasing median right atrial area (23, 26, 29 cm2, respectively; P<0.005), RV area in diastole (21, 27, 27 cm2, respectively; P<0.005), and pulmonary vascular resistance (2.4, 2.9, 3.6 woods units, respectively; P=0.003), and lower RV stroke work index (8.6, 8.4, 5.5 g·m/m2 per beat, respectively; P<0.001). RAP/PCWP ratio was associated with death or hospitalization within 6 months (hazard ratio, 1.16 [1, 1.4]; P<0.05). Increased RAP/PCWP ratio was associated with higher pulmonary vascular resistance, reduced RV function (manifest as a larger right atrium and ventricle and lower RV stroke work index), and an increased risk of adverse outcomes in patients with advanced heart failure.

  17. Value maximizing maintenance policies under general repair

    International Nuclear Information System (INIS)

    Marais, Karen B.

    2013-01-01

    One class of maintenance optimization problems considers the notion of general repair maintenance policies where systems are repaired or replaced on failure. In each case the optimality is based on minimizing the total maintenance cost of the system. These cost-centric optimizations ignore the value dimension of maintenance and can lead to maintenance strategies that do not maximize system value. This paper applies these ideas to the general repair optimization problem using a semi-Markov decision process, discounted cash flow techniques, and dynamic programming to identify the value-optimal actions for any given time and system condition. The impact of several parameters on maintenance strategy, such as operating cost and revenue, system failure characteristics, repair and replacement costs, and the planning time horizon, is explored. This approach provides a quantitative basis on which to base maintenance strategy decisions that contribute to system value. These decisions are different from those suggested by traditional cost-based approaches. The results show (1) how the optimal action for a given time and condition changes as replacement and repair costs change, and identifies the point at which these costs become too high for profitable system operation; (2) that for shorter planning horizons it is better to repair, since there is no time to reap the benefits of increased operating profit and reliability; (3) how the value-optimal maintenance policy is affected by the system's failure characteristics, and hence whether it is worthwhile to invest in higher reliability; and (4) the impact of the repair level on the optimal maintenance policy. -- Highlights: •Provides a quantitative basis for maintenance strategy decisions that contribute to system value. •Shows how the optimal action for a given condition changes as replacement and repair costs change. •Shows how the optimal policy is affected by the system's failure characteristics. •Shows when it is

  18. Licensing of advanced reactors: Status report and perspective

    International Nuclear Information System (INIS)

    King, T.

    1988-01-01

    In July, 1986, the U.S. Nuclear Regulatory Commission issued a Policy State on the Regulation of Advanced Nuclear Power Plants. As part of this policy, advanced reactor designers were encouraged to interact with NRC [Nuclear Regulatory Commission] early in the design process to obtain feedback regarding licensing requirements for advanced reactors. Accordingly, the staff has been interacting with the Department of Energy (DOE) and its contractors on the review of three advanced reactor conceptual designs: one modular high temperature gas-cooled reactor (MHTGR) and two liquid metal reactors (LMRs). This paper provides a status of the NRC review effort, describes the key policy and technical issues resulting from our review and provides the current status and approach to the development of licensing guidance on each

  19. Emerging environmental technologies and environmental technology policy

    Science.gov (United States)

    Clarke, Leon Edward

    This dissertation explores the role and design of environmental technology policy when environmental innovation is embodied in emerging environmental technologies such as photovoltaic cells or fuel cells. The dissertation consists of three individual studies, all of which use a simplified, general model industry between an emerging environmental technology and an entrenched, more-polluting technology. It clarifies the situations in which environmental technology policy can achieve high welfare and those in which it cannot; and it separates the possible situations an emerging environmental technology might face into four scenarios, each with its own technology policy recommendations. The second study attempts to clarify which of two factors is having a larger limiting effect on private investment in photovoltaics: the failure to internalize the environmental costs of fossil fuel electricity generation or a broad set of innovation market failures that apply to innovation irrespective of environmental concerns. The study indicates that innovation market failures are probably having a significantly larger impact than incomplete internalization. The third study explores the effectiveness of adoption subsidies at encouraging private-sector innovation. The conclusion is that adoption subsidies probably have only a limited effect on long-term, private-sector research. Two important general conclusions of the dissertation are (1) that optimal technology policy should begin with technology-push measures and end with demand-pull measures; and (2) that the technological response to internalization instruments, such as emissions taxes, may be highly nonlinear.

  20. Failure probability analysis of optical grid

    Science.gov (United States)

    Zhong, Yaoquan; Guo, Wei; Sun, Weiqiang; Jin, Yaohui; Hu, Weisheng

    2008-11-01

    Optical grid, the integrated computing environment based on optical network, is expected to be an efficient infrastructure to support advanced data-intensive grid applications. In optical grid, the faults of both computational and network resources are inevitable due to the large scale and high complexity of the system. With the optical network based distributed computing systems extensive applied in the processing of data, the requirement of the application failure probability have been an important indicator of the quality of application and an important aspect the operators consider. This paper will present a task-based analysis method of the application failure probability in optical grid. Then the failure probability of the entire application can be quantified, and the performance of reducing application failure probability in different backup strategies can be compared, so that the different requirements of different clients can be satisfied according to the application failure probability respectively. In optical grid, when the application based DAG (directed acyclic graph) is executed in different backup strategies, the application failure probability and the application complete time is different. This paper will propose new multi-objective differentiated services algorithm (MDSA). New application scheduling algorithm can guarantee the requirement of the failure probability and improve the network resource utilization, realize a compromise between the network operator and the application submission. Then differentiated services can be achieved in optical grid.

  1. Success and failure factors for e-government projects: A case from Egypt

    Directory of Open Access Journals (Sweden)

    Hatem Elkadi

    2013-07-01

    Full Text Available E-government implementations in developing countries still face difficulties, leading to a large failure ratio. This is too high a cost for developing countries. Analysis of the reasons behind success and failure of e-government projects is still an interesting domain of investigation. Several approaches were advanced and success and failure factors have been stipulated, but factors pertinent to Public Administration have yet to be investigated and analyzed. This work builds on the results of earlier research, analyzing the factors behind the change in performance of the different sites of a specific project, reasons of their original success, and the relapse of one site. It reviews in detail the factors advanced by previous works and integrates for the first time the results obtained by 3 different research methodologies. It clarifies the causality between different factors presumed to individually affect the e-government implementations, thus enabling the disambiguation between the main and secondary less effective causes of failure. The success and failure factors significance and relative importance are identified, revealing the recommended track of action for the set-back remedy.

  2. Cardiac Stress and Inflammatory Markers as Predictors of Heart Failure in Patients With Type 2 Diabetes: The ADVANCE Trial.

    Science.gov (United States)

    Ohkuma, Toshiaki; Jun, Min; Woodward, Mark; Zoungas, Sophia; Cooper, Mark E; Grobbee, Diederick E; Hamet, Pavel; Mancia, Giuseppe; Williams, Bryan; Welsh, Paul; Sattar, Naveed; Shaw, Jonathan E; Rahimi, Kazem; Chalmers, John

    2017-09-01

    This study examined the individual and combined effect of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and hs-CRP on the prediction of heart failure incidence or progression in patients with type 2 diabetes. A nested case-cohort study was conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37, 3.96) for NT-proBNP, 1.50 (1.27, 1.77) for hs-cTnT, 1.48 (1.27, 1.72) for IL-6, and 1.32 (1.12, 1.55) for hs-CRP. The addition of NT-proBNP to the model including conventional risk factors meaningfully improved 5-year risk-predictive performance (C statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [10% 5-year risk] 24.2%). In contrast, the addition of hs-cTnT, IL-6, or hs-CRP did not improve the prediction metrics consistently in combination or when added to NT-proBNP. Only NT-proBNP strongly and consistently improved the prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers. © 2017 by the American Diabetes Association.

  3. Physical training in patients with heart failure

    Directory of Open Access Journals (Sweden)

    Barbara Fletcher, RN, MN, FAAN

    2012-11-01

    Full Text Available Heart failure is a primary health concern in North and South America, with hospitalizations for heart failure as the primary diagnosis continuing to rise. There is a positive relationship between the prevalence of heart failure and age. However, mortality from heart failure is on the decline due to medical advancements, pharmacotherapy and nonpharmacological interventions. One of these nonpharmacological interventions is physical training or exercise. Physical training or exercise is becoming widely accepted by the medical community as a viable option in the medical management of stable heart failure patients. Both aerobic and resistance type exercise have been shown to be efficacious in stable heart failure patients. Evidence now exists not only supporting exercise to improve or maintain physical function in heart failure patients, but also quality of life. Many studies have shown that utilizing exercise in this population improves mood and overall self-reported well being. While the myocardial benefits from exercise may be minimal in heart failure patients, the peripheral benefits leading to improved physical function and preservation of independence are indispensible. Based on the research that has been conducted in the area of exercise and heart failure to this point, clinicians working with this population have the data necessary to prescribe evidence-based exercise prescriptions that can be utilized as part of a comprehensive medical management approach. Currently, several medical position statements endorse exercise as a safe and effective modality in heart failure patients.

  4. Geographic differences in heart failure trials.

    Science.gov (United States)

    Ferreira, João Pedro; Girerd, Nicolas; Rossignol, Patrick; Zannad, Faiez

    2015-09-01

    Randomized controlled trials (RCTs) are essential to develop advances in heart failure (HF). The need for increasing numbers of patients (without substantial cost increase) and generalization of results led to the disappearance of international boundaries in large RCTs. The significant geographic differences in patients' characteristics, outcomes, and, most importantly, treatment effect observed in HF trials have recently been highlighted. Whether the observed regional discrepancies in HF trials are due to trial-specific issues, patient heterogeneity, structural differences in countries, or a complex interaction between factors are the questions we propose to debate in this review. To do so, we will analyse and review data from HF trials conducted in different world regions, from heart failure with preserved ejection fraction (HF-PEF), heart failure with reduced ejection fraction (HF-REF), and acute heart failure (AHF). Finally, we will suggest objective and actionable measures in order to mitigate regional discrepancies in future trials, particularly in HF-PEF where prognostic modifying treatments are urgently needed and in which trials are more prone to selection bias, due to a larger patient heterogeneity. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

  5. Management of Advanced Heart Failure in the Elderly: Ethics, Economics, and Resource Allocation in the Technological Era

    Directory of Open Access Journals (Sweden)

    Keith M. Swetz

    2012-01-01

    Full Text Available Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS. Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein.

  6. On preventive maintenance policy of a critical reliability level for system subject to degradation

    International Nuclear Information System (INIS)

    Zhao, Y.X.

    2003-01-01

    Conventional preventive maintenance (PM) policies generally hold same time interval for PM actions and are often applied with known failure modes. The same time interval will give unavoidably decreasing reliabilities at the PM actions for degradation system with imperfect PM effect and the known failure modes may be inaccurate in practice. Therefore, field managers would prefer policy with an acceptable reliability level to keep system often at a good state. A PM policy with the critical reliability level is presented to address the preference of field managers. Through assuming that system after a PM action starts a new failure process, a parameter so-called degradation ratio is introduced to represent the imperfect effect. The policy holds a law that there is same number of failures in the time intervals of various PM cycles, and same degradation ratio for the system reliability or benefit parameters such as the optimal time intervals and the hazard rates between the neighboring PM cycles. This law is valid to any of the failure modes that could be appropriately referred as a 'general isodegrading model', and the degradation ratio as a 'general isodegrading ratio'. In addition, life cycle availability and cost functions are derived for system with the policy. An analysis of the field data of a loading and unloading machine indicates that the reliability, availability and cost in life cycle might be well modeled by the present theory and approach

  7. Between Accommodating and Activating: Framing Policy Reforms in Response to Workforce Aging across Europe.

    Science.gov (United States)

    Kroon, Anne C; Vliegenthart, Rens; van Selm, Martine

    2017-07-01

    In the past decade, European governments have implemented activating policy reforms to maximize older workers' employment and employability, representing a paradigmatic change in approaches to work and retirement. This study isolates the factors that explain the relative success and failure of competitive frames that are either in favor of or against activating policies in European news coverage, by applying time-series analysis (ordinary least squares with panel-corrected standard errors) to monthly aggregated news coverage in the Netherlands, the United Kingdom, Denmark, and Spain over the timespan 2006-2013. The results show that pro-activating and counteractivating frames generally coincide in competitive framing environments. The pro-activating frame proliferated in times of high employment protection, whereas the counteractivating frame prevailed stronger in conservative compared with progressive newspapers, and gained momentum during the aftermath of the financial crisis and in times governments on the economic left were in power. The study advances knowledge of competitive issue framing by demonstrating how the economic, policy, and political context matters for the emergence and evolvement of competing frames. In addition, the findings contribute to the understanding of the factors that contribute to news representations that promote active aging in European news, which may foster support for policy reforms that sustain older workers' employability.

  8. Iridium: failures & successes

    Science.gov (United States)

    Christensen, CarissaBryce; Beard, Suzette

    2001-03-01

    This paper will provide an overview of the Iridium business venture in terms of the challenges faced, the successes achieved, and the causes of the ultimate failure of the venture — bankruptcy and system de-orbit. The paper will address technical, business, and policy issues. The intent of the paper is to provide a balanced and accurate overview of the Iridium experience, to aid future decision-making by policy makers, the business community, and technical experts. Key topics will include the history of the program, the objectives and decision-making of Motorola, the market research and analysis conducted, partnering strategies and their impact, consumer equipment availability, and technical issues — target performance, performance achieved, technical accomplishments, and expected and unexpected technical challenges. The paper will use as sources trade media and business articles on the Iridium program, technical papers and conference presentations, Wall Street analyst's reports, and, where possible, interviews with participants and close observers.

  9. Critical review of jatropha biodiesel promotion policies in India

    International Nuclear Information System (INIS)

    Kumar, Sunil; Chaube, Alok; Jain, Shashi Kumar

    2012-01-01

    Jatropha, a non-edible oil seed yielding plant has been identified by the Government of India to produce biodiesel under National Biodiesel Mission. Failure of phase-I of National Biodiesel Mission and likely failure of phase-II requires critical analysis of policy frameworks related to its long term sustainability. Indian biofuel promotion policies like Biodiesel Purchase Policy and National Biofuel Policy have failed to yield any visible results. No tangible ground work is visible as of now to ensure success of various government plans and policies related to adoption of jatropha biodiesel. It is clearly evident that some serious bottlenecks are delaying the adoption of jatropha biodiesel. Present work identifies important policy bottlenecks like availability of land, non-remunerative pricing policy and state fear relating to loss of revenue in the case of zero duty regimes. This paper attempts to explore and critically analyze present policies and possible options taking into account the recent Indian experiences for successful adoption of jatropha biodiesel. - Highlights: ► Wrong waste land estimates for jatropha has failed Biodiesel Mission. ► No redressal of technological problems with biodiesel usage. ► Present estimated costing of jatropha biodiesel is Rs. 46.45 per liter. ► Promotion of any biofuel needs central government assistance to the states. ► Targets under National Biofuel Policy are also unlikely to be met.

  10. Characterization of a novel symptom of advanced heart failure: bendopnea.

    Science.gov (United States)

    Thibodeau, Jennifer T; Turer, Aslan T; Gualano, Sarah K; Ayers, Colby R; Velez-Martinez, Mariella; Mishkin, Joseph D; Patel, Parag C; Mammen, Pradeep P A; Markham, David W; Levine, Benjamin D; Drazner, Mark H

    2014-02-01

    This study sought to examine the frequency and hemodynamic correlates of shortness of breath when bending forward, a symptom we have termed "bendopnea." Many heart failure patients describe bendopnea such as when putting on their shoes. This symptom has not previously been characterized. We conducted a prospective study of 102 subjects with systolic heart failure referred for right-heart catheterization. Time to onset of bendopnea was measured prior to catheterization. Forty-six subjects also underwent hemodynamic assessment when sitting and bending. Hemodynamic profiles were assigned on the basis of whether pulmonary capillary wedge pressure (PCWP) was ≥ 22 mm Hg and cardiac index (CI) was ≤ 2.2 l/min/m(2). Bendopnea was present in 29 of 102 (28%) subjects with median (25th, 75th percentiles) time to onset of 8 (7, 11) seconds. Subjects with bendopnea had higher supine right atrial pressure (RAP) (p = 0.001) and PCWP (p = 0.0004) than those without bendopnea but similar CI (p = 0.2). RAP and PCWP increased comparably in subjects with and without bendopnea when bending, but CI did not change. In those with, versus without, bendopnea, there was more than a 3-fold higher frequency of a supine hemodynamic profile consisting of elevated PCWP with low CI (55% vs. 16%, respectively, p < 0.001) but no association with a profile of elevated PCWP with normal CI (p = 0.95). Bendopnea is mediated via a further increase in filling pressures during bending when filling pressures are already high, particularly if CI is reduced. Awareness of bendopnea should improve noninvasive assessment of hemodynamics in subjects with heart failure. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  11. Policy Implications Analysis: A Methodological Advancement for Policy Research and Evaluation.

    Science.gov (United States)

    Madey, Doren L.; Stenner, A. Jackson

    Policy Implications Analysis (PIA) is a tool designed to maximize the likelihood that an evaluation report will have an impact on decision-making. PIA was designed to help people planning and conducting evaluations tailor their information so that it has optimal potential for being used and acted upon. This paper describes the development and…

  12. Forecasting overhaul or replacement intervals based on estimated system failure intensity

    Science.gov (United States)

    Gannon, James M.

    1994-12-01

    System reliability can be expressed in terms of the pattern of failure events over time. Assuming a nonhomogeneous Poisson process and Weibull intensity function for complex repairable system failures, the degree of system deterioration can be approximated. Maximum likelihood estimators (MLE's) for the system Rate of Occurrence of Failure (ROCOF) function are presented. Evaluating the integral of the ROCOF over annual usage intervals yields the expected number of annual system failures. By associating a cost of failure with the expected number of failures, budget and program policy decisions can be made based on expected future maintenance costs. Monte Carlo simulation is used to estimate the range and the distribution of the net present value and internal rate of return of alternative cash flows based on the distributions of the cost inputs and confidence intervals of the MLE's.

  13. Animal Production Research Advances: Editorial Policies

    African Journals Online (AJOL)

    Focus and Scope. Animal production research advances is a peer-review journal established expressly to promote the production of all animal species utilized as food. The journal has an international scope and is intended for professionals in animal production and related sciences. We solicit contributions from animal ...

  14. Young Adults Failure to Thrive Syndrome

    Directory of Open Access Journals (Sweden)

    Warren C. Sanderson

    2014-03-01

    Full Text Available Many young working age adults in developed countries are failing to thrive in economic, demographic and social terms. Their failure to thrive is a relatively new phenomenon that has not been widely recognized, but it affects young adults in virtually all the more developed countries for which we have relevant data. Young adults nowadays are more often in poverty. They are leaving their parental homes at ever later ages and in some countries the frequency of psychological problems increased. The seriousness of failure to thrive syndrome is reflected in the relationship between relative economic conditions and increased suicide rates. The syndrome is important because young adults are at the prime ages for finding employment, establishing long-run career paths and building an economic basis for founding a family. Developing strategies to arrest the spread of failure to thrive syndrome among young adults, in order to keep them vibrant contributors to our societies, should be a priority for policy makers.

  15. Sustainable cities and energy policies

    International Nuclear Information System (INIS)

    Capello, R.; Nijkamp, P.; Pepping, G.

    1999-01-01

    This book starts out with the optimistic perspective that modern cities can indeed play a strategic role in the necessary pathway to sustainable development, with particular emphasis on the opportunities offered by local energy and environmental initiatives. Our study aims to demonstrate that an urban sustainability policy has many socio-economic benefits, while it also seeks to identify the critical success and failure factors of sustainable city innovations. After a comprehensive review of various opportunities and experiences, attention is focused particularly on renewable energy resources which may offer new potential for the active involvement of local authorities. The study also highlights major impediments regarding the adoption and implementation of renewable energies, in particular, the development of advanced energy-environmental technology in a world dominated by natural (public) monopolies and/or monopolistic competition elements. In this context both theoretical and empirical elements are discussed, as well as institutional aspects. The theory and methodology is tested by a thorough empirical investigation into local renewable energy initiatives in three European countries, viz. Greece, Italy and The Netherlands. Based on an extensive data base, various statistical models are estimated in order to identify the key elements and major driving forces of sustainable development at the city level. And finally, the study is concluded with a long list of applicable and operational policy guidelines for urban sustainability. These lessons are largely based on meta-analytic comparative studies of the various initiatives investigated. (orig.)

  16. Review of Togolese agricultural policies from independence in 1960 ...

    African Journals Online (AJOL)

    The green revolution policy launched in the aftermath of independence could have resulted in the upswing of Togolese agriculture sector and shift it towards modernisation and market orientation. Unfortunately, the weakness of institutions in charge of its implementation and carelessness of policy process led to its failure.

  17. Family caregiving during 1-year follow-up in individuals with advanced chronic organ failure

    NARCIS (Netherlands)

    Nakken, Nienke; Spruit, Martijn A.; Wouters, Emiel F. M.; Schols, J.M.G.A.; Janssen, Daisy J. A.

    2015-01-01

    Background Family caregivers already have a paramount role in daily care for patients with chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), or chronic renal failure (CRF). To date, it remains unknown whether and to what extent the experience of caregiving changes over time.

  18. Emerging indications for extracorporeal membrane oxygenation in adults with respiratory failure.

    Science.gov (United States)

    Abrams, Darryl; Brodie, Daniel

    2013-08-01

    Recent advances in technology have spurred the increasing use of extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure. However, this accounts for only a small percentage of patients with respiratory failure. We envision the application of ECMO in many other forms of respiratory failure in the coming years. Patients with less severe forms of acute respiratory distress syndrome, for instance, may benefit from enhanced lung-protective ventilation with the very low tidal volumes made possible by direct carbon dioxide removal from the blood. For those in whom hypercapnia predominates, extracorporeal support will allow for the elimination of invasive mechanical ventilation in some cases. The potential benefits of ECMO may be further enhanced by improved techniques, which facilitate active mobilization. Although ECMO for these and other expanded applications is under active investigation, it has yet to be proven beneficial in these settings in rigorous controlled trials. Ultimately, with upcoming and future technological advances, there is the promise of true destination therapy, which could lead to a major paradigm shift in the management of respiratory failure.

  19. The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure.

    Science.gov (United States)

    Kane, P M; Murtagh, F E M; Ryan, K; Mahon, N G; McAdam, B; McQuillan, R; Ellis-Smith, C; Tracey, C; Howley, C; Raleigh, C; O'Gara, G; Higginson, I J; Daveson, B A

    2015-11-01

    Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II-IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included 'patient-centred care', 'quality of life' and 'shared decision making'. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations.

  20. Advancing public health obesity policy through state attorneys general.

    Science.gov (United States)

    Pomeranz, Jennifer L; Brownell, Kelly D

    2011-03-01

    Obesity in the United States exacts a heavy health and financial toll, requiring new approaches to address this public health crisis. State attorneys general have been underutilized in efforts to formulate and implement food and obesity policy solutions. Their authority lies at the intersection of law and public policy, creating unique opportunities unavailable to other officials and government entities. Attorneys general have a broad range of authority over matters specifically relevant to obesity and nutrition policy, including parens patriae (parent of the country) authority, protecting consumer interests, enacting and supporting rules and regulations, working together across states, engaging in consumer education, and drafting opinions and amicus briefs. Significant room exists for greater attorney general involvement in formulating and championing solutions to public health problems such as obesity.

  1. R and D Subsidies and Climate Policy. Is There a 'Free Lunch'?

    International Nuclear Information System (INIS)

    Popp, D.

    2006-01-01

    Because of the long-term nature of the climate problem, technological advances are often seen as an important component of any solution. However, when considering the potential for technology to help solve the climate problem, two market failures exist which lead to underinvestment in climate-friendly R and D: environmental externalities and the public goods nature of new knowledge. As a result, government subsidies to climate-friendly R and D projects are often proposed as part of a policy solution. Using the ENTICE model, I analyze the effectiveness of such subsidies, both with and without other climate policies, such as a carbon tax. While R and D subsidies do lead to significant increases in climate-friendly R and D, this R and D has little impact on the climate itself. Subsidies address the problem of knowledge as a public good, but they do not address the environmental externality, and thus offer no additional incentive to adopt new technologies. Moreover, high opportunity costs to R and D limit the potential role that subsidies can play. While R and D subsidies can improve efficiency, policies that directly affect the environmental externality have a much larger impact on both atmospheric temperature and economic welfare

  2. The ADHF/NT-proBNP risk score to predict 1-year mortality in hospitalized patients with advanced decompensated heart failure.

    Science.gov (United States)

    Scrutinio, Domenico; Ammirati, Enrico; Guida, Pietro; Passantino, Andrea; Raimondo, Rosa; Guida, Valentina; Sarzi Braga, Simona; Canova, Paolo; Mastropasqua, Filippo; Frigerio, Maria; Lagioia, Rocco; Oliva, Fabrizio

    2014-04-01

    The acute decompensated heart failure/N-terminal pro-B-type natriuretic peptide (ADHF/NT-proBNP) score is a validated risk scoring system that predicts mortality in hospitalized heart failure patients with a wide range of left ventricular ejection fractions (LVEFs). We sought to assess discrimination and calibration of the score when applied to patients with advanced decompensated heart failure (AHF). We studied 445 patients hospitalized for AHF, defined by the presence of severe symptoms of worsening HF at admission, severely depressed LVEF, and the need for intravenous diuretic and/or inotropic drugs. The primary outcome was cumulative (in-hospital and post-discharge) mortality and post-discharge 1-year mortality. Separate analyses were performed for patients aged ≤ 70 years. A Seattle Heart Failure Score (SHFS) was calculated for each patient discharged alive. During follow-up, 144 patients (32.4%) died, and 69 (15.5%) underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. After accounting for the competing events (VAD/HT), the ADHF/NT-proBNP score's C-statistic for cumulative mortality was 0.738 in the overall cohort and 0.771 in patients aged ≤ 70 years. The C-statistic for post-discharge mortality was 0.741 and 0.751, respectively. Adding prior (≤6 months) hospitalizations for HF to the score increased the C-statistic for post-discharge mortality to 0.759 in the overall cohort and to 0.774 in patients aged ≤ 70 years. Predicted and observed mortality rates by quartiles of score were highly correlated. The SHFS demonstrated adequate discrimination but underestimated the risk. The ADHF/NT-proBNP risk calculator is available at http://www.fsm.it/fsm/file/NTproBNPscore.zip. Our data suggest that the ADHF/NT-proBNP score may efficiently predict mortality in patients hospitalized with AHF. Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  3. Development of an Advanced Digital Reactor Protection System Using Diverse Dual Processors to Prevent Common-Mode Failure

    International Nuclear Information System (INIS)

    Shin, Hyun Kook; Nam, Sang Ku; Sohn, Se Do; Chang, Hoon Seon

    2003-01-01

    The advanced digital reactor protection system (ADRPS) with diverse dual processors has been developed to prevent common-mode failure (CMF). The principle of diversity is applied to both hardware design and software design. For hardware diversity, two different types of CPUs are used for the bistable processor and local coincidence logic (LCL) processor. The Versa Module Eurocard-based single board computers are used for the CPU hardware platforms. The QNX operating system and the VxWorks operating system were selected for software diversity. Functional diversity is also applied to the input and output modules, and to the algorithm in the bistable processors and LCL processors. The characteristics of the newly developed digital protection system are described together with the preventive capability against CMF. Also, system reliability analysis is discussed. The evaluation results show that the ADRPS has a good preventive capability against the CMF and is a highly reliable reactor protection system

  4. Asymptotic failure rate of a continuously monitored system

    International Nuclear Information System (INIS)

    Grall, A.; Dieulle, L.; Berenguer, C.; Roussignol, M.

    2006-01-01

    This paper deals with a perfectly continuously monitored system which gradually and stochastically deteriorates. The system is renewed by a delayed maintenance operation, which is triggered when the measured deterioration level exceeds an alarm threshold. A mathematical model is developed to study the asymptotic behavior of the reliability function. A procedure is proposed which allows us to identify the asymptotic failure rate of the maintained system. Numerical experiments illustrate the efficiency of the proposed procedure and emphasize the relevance of the asymptotic failure rate as an interesting indicator for the evaluation of the control-limit preventive replacement policy

  5. Asymptotic failure rate of a continuously monitored system

    Energy Technology Data Exchange (ETDEWEB)

    Grall, A. [Institut des Sciences et Technologies de l' Information de Troyes (CNRS-FRE 2732), Equipe de Modelisation et de Surete des Systemes, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: antoine.grall@utt.fr; Dieulle, L. [Institut des Sciences et Technologies de l' Information de Troyes (CNRS-FRE 2732), Equipe de Modelisation et de Surete des Systemes, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: laurence.dieulle@utt.fr; Berenguer, C. [Institut des Sciences et Technologies de l' Information de Troyes (CNRS-FRE 2732), Equipe de Modelisation et de Surete des Systemes, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: christophe.berenguer@utt.fr; Roussignol, M. [Laboratoire d' Analyse et de Mathematiques Appliquees, Universite de Marne la Vallee, 5 bd Descartes, Champs sur Marne, 77454 Marne la Vallee, Cedex 2 (France)]. E-mail: michel.roussignol@univ-mlv.fr

    2006-02-01

    This paper deals with a perfectly continuously monitored system which gradually and stochastically deteriorates. The system is renewed by a delayed maintenance operation, which is triggered when the measured deterioration level exceeds an alarm threshold. A mathematical model is developed to study the asymptotic behavior of the reliability function. A procedure is proposed which allows us to identify the asymptotic failure rate of the maintained system. Numerical experiments illustrate the efficiency of the proposed procedure and emphasize the relevance of the asymptotic failure rate as an interesting indicator for the evaluation of the control-limit preventive replacement policy.

  6. Constructing Ontology for Knowledge Sharing of Materials Failure Analysis

    Directory of Open Access Journals (Sweden)

    Peng Shi

    2014-01-01

    Full Text Available Materials failure indicates the fault with materials or components during their performance. To avoid the reoccurrence of similar failures, materials failure analysis is executed to investigate the reasons for the failure and to propose improved strategies. The whole procedure needs sufficient domain knowledge and also produces valuable new knowledge. However, the information about the materials failure analysis is usually retained by the domain expert, and its sharing is technically difficult. This phenomenon may seriously reduce the efficiency and decrease the veracity of the failure analysis. To solve this problem, this paper adopts ontology, a novel technology from the Semantic Web, as a tool for knowledge representation and sharing and describes the construction of the ontology to obtain information concerning the failure analysis, application area, materials, and failure cases. The ontology represented information is machine-understandable and can be easily shared through the Internet. At the same time, failure case intelligent retrieval, advanced statistics, and even automatic reasoning can be accomplished based on ontology represented knowledge. Obviously this can promote the knowledge sharing of materials service safety and improve the efficiency of failure analysis. The case of a nuclear power plant area is presented to show the details and benefits of this method.

  7. Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us.

    Science.gov (United States)

    Fung, Erik; Hui, Elsie; Yang, Xiaobo; Lui, Leong T; Cheng, King F; Li, Qi; Fan, Yiting; Sahota, Daljit S; Ma, Bosco H M; Lee, Jenny S W; Lee, Alex P W; Woo, Jean

    2018-01-01

    Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO) study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management.

  8. Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us

    Science.gov (United States)

    Fung, Erik; Hui, Elsie; Yang, Xiaobo; Lui, Leong T.; Cheng, King F.; Li, Qi; Fan, Yiting; Sahota, Daljit S.; Ma, Bosco H. M.; Lee, Jenny S. W.; Lee, Alex P. W.; Woo, Jean

    2018-01-01

    Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO) study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management. PMID:29740330

  9. Progenitor Hematopoietic Cells Implantation Improves Functional Capacity of End Stage Coronary Artery Disease Patients with Advanced Heart Failure

    Directory of Open Access Journals (Sweden)

    Yoga Yuniadi

    2016-01-01

    Full Text Available Background. Proangiogenic Hematopoietic Cells (PHC which comprise diverse mixture of cell types are able to secrete proangiogenic factors and interesting candidate for cell therapy. The aim of this study was to seek for benefit in implantation of PHC on functional improvement in end stage coronary artery disease patients with advanced heart failure. Methods. Patients with symptomatic heart failure despite guideline directed medical therapy and LVEF less than 35% were included. Peripheral blood mononuclear cells were isolated, cultivated for 5 days, and then harvested. Flow cytometry and cell surface markers were used to characterize PHC. The PHC were delivered retrogradely via sinus coronarius. Echocardiography, myocardial perfusion, and clinical and functional data were analyzed up to 1-year observation. Results. Of 30 patients (56.4±7.40 yo preimplant NT proBNP level is 5124.5±4682.50 pmol/L. Harvested cells characterized with CD133, CD34, CD45, and KDR showed 0.87±0.41, 0.63±0.66, 99.00±2.60, and 3.22±3.79%, respectively. LVEF was improved (22±5.68 versus 26.8±7.93, p<0.001 during short and long term observation. Myocardial perfusion significantly improved 6 months after treatment. NYHA Class and six-minute walk test are improved during short term and long term follow-up. Conclusion. Expanded peripheral blood PHC implantation using retrograde delivery approach improved LV systolic function, myocardial perfusion, and functional capacity.

  10. Triggers of State Failure

    Science.gov (United States)

    2010-03-01

    à 1990) à l’aide de données collatérales additionnelles. Les auteurs du document n’ont pas essayé de suivre les événements qui étaient en cours...défaillance étatique, et les auteurs du document ont reconnu qu’il ne serait pas très utile de reproduire toutes ces informations. Le document s’appuie le...30 Carment, David. Assessing state failure: implications for theory and policy. in Third World Quarterly. Vol 24, no 3. pp 407-427. 30 DRDC

  11. Analysis of an M/G/1 Queue with Multiple Vacations, N-policy, Unreliable Service Station and Repair Facility Failures

    Directory of Open Access Journals (Sweden)

    Wenqing Wu

    2014-05-01

    Full Text Available This paper studies an M/G/1 repairable queueing system with multiple vacations and N-policy, in which the service station is subject to occasional random breakdowns. When the service station breaks down, it is repaired by a repair facility. Moreover, the repair facility may fail during the repair period of the service station. The failed repair facility resumes repair after completion of its replacement. Under these assumptions, applying a simple method, the probability that the service station is broken, the rate of occurrence of breakdowns of the service station, the probability that the repair facility is being replaced and the rate of occurrence of failures of the repair facility along with other performance measures are obtained. Following the construction of the long-run expected cost function per unit time, the direct search method is implemented for determining the optimum threshold N* that minimises the cost function.

  12. Characteristics and outcome of patients with heart failure due to anabolic-androgenic steroids

    DEFF Research Database (Denmark)

    Søndergaard, Eva Bjerre; Thune, Jens Jakob; Gustafsson, Finn

    2014-01-01

    OBJECTIVES: The objective of the study was to analyse the outcome of patients with advanced heart failure due to abuse of anabolic-androgenic steroids. DESIGN: A retrospective chart review of patients admitted or referred for advanced heart failure, due to anabolic-androgenic steroid abuse...... with angiotensin-converting enzyme inhibitors and beta-blockers. The remaining 3 patients required implantation of a LV assist device (LVAD) and were listed for heart transplantation. No recovery of LV function in the patients treated with assist device was seen. CONCLUSION: Anabolic-androgenic steroid...

  13. AdvanceVT Newsletter: February 2004

    OpenAIRE

    AdvanceVT

    2004-01-01

    Inside this issue: Today's Leadership Seminar; Women's Month Reception; Child Care Survey National Science Foundation The AdvanceVT Team Elizabeth Creamer, Assessment Director Associate Professor of Educational Leadership and Policy Studies Catherine Eckel, ADVANCE Professor Professor of Economics Patricia Hyer, Principle Investigator Associate Provost for Academic Administration Barbara Johnson, Administrative Assistant Peggy Layne, Project Coordinator Nancy Love, Co-PI and ADVANCE Pro...

  14. Long-term outcome and patterns of failure in patients with advanced head and neck cancer

    International Nuclear Information System (INIS)

    Hauswald, Henrik; Simon, Christian; Hecht, Simone; Debus, Juergen; Lindel, Katja

    2011-01-01

    To access the long-time outcome and patterns of failure in patients with advanced head and neck squamous cell carcinoma (HNSCC). Between 1992 and 2005 127 patients (median age 55 years, UICC stage III n = 6, stage IV n = 121) with primarily inoperable, advanced HNSCC were treated with definite platinum-based radiochemotherapy (median dose 66.4 Gy). Analysed end-points were overall survival (OS), disease-free survival (DFS), loco-regional progression-free survival (LPFS), development of distant metastases (DM), prognostic factors and causes of death. The mean follow-up time was 34 months (range, 3-156 months), the 3-, 5- and 10-year OS rates were 39%, 28% and 14%, respectively. The median OS was 23 months. Forty-seven patients achieved a complete remission and 78 patients a partial remission. The median LPFS was 17 months, the 3-, 5- and 10-year LPFS rates were 41%, 33% and 30%, respectively. The LPFS was dependent on the nodal stage (p = 0.029). The median DFS was 11 months (range, 2-156 months), the 3-, 5- and 10-year DFS rates were 30%, 24% and 22%, respectively. Prognostic factors in univariate analyses were alcohol abuse (n = 102, p = 0.015), complete remission (n = 47, p < 0.001), local recurrence (n = 71, p < 0.001), development of DM (n = 45, p < 0.001; median OS 16 months) and borderline significance in nodal stage N2 versus N3 (p = 0.06). Median OS was 26 months with lung metastases (n = 17). Nodal stage was a predictive factor for the development of DM (p = 0.025). Cause of death was most commonly tumor progression. In stage IV HNSCC long-term survival is rare and DM is a significant predictor for mortality. If patients developed DM, lung metastases had the most favourable prognosis, so intensified palliative treatment might be justified in DM limited to the lungs

  15. Iron deficiency and anemia in heart failure.

    Science.gov (United States)

    Çavuşoğlu, Yüksel; Altay, Hakan; Çetiner, Mustafa; Güvenç, Tolga Sinan; Temizhan, Ahmet; Ural, Dilek; Yeşilbursa, Dilek; Yıldırım, Nesligül; Yılmaz, Mehmet Birhan

    2017-03-01

    Heart failure is an important community health problem. Prevalence and incidence of heart failure have continued to rise over the years. Despite recent advances in heart failure therapy, prognosis is still poor, rehospitalization rate is very high, and quality of life is worse. Co-morbidities in heart failure have negative impact on clinical course of the disease, further impair prognosis, and add difficulties to treatment of clinical picture. Therefore, successful management of co-morbidities is strongly recommended in addition to conventional therapy for heart failure. One of the most common co-morbidities in heart failure is presence of iron deficiency and anemia. Current evidence suggests that iron deficiency and anemia are more prevalent in patients with heart failure and reduced ejection fraction, as well as those with heart failure and preserved ejection fraction. Moreover, iron deficiency and anemia are referred to as independent predictors for poor prognosis in heart failure. There is strong relationship between iron deficiency or anemia and severity of clinical status of heart failure. Over the last two decades, many clinical investigations have been conducted on clinical effectiveness of treatment of iron deficiency or anemia with oral iron, intravenous iron, and erythropoietin therapies. Studies with oral iron and erythropoietin therapies did not provide any clinical benefit and, in fact, these therapies have been shown to be associated with increase in adverse clinical outcomes. However, clinical trials in patients with iron deficiency in the presence or absence of anemia have demonstrated considerable clinical benefits of intravenous iron therapy, and based on these positive outcomes, iron deficiency has become target of therapy in management of heart failure. The present report assesses current approaches to iron deficiency and anemia in heart failure in light of recent evidence.

  16. Neoadjuvant versus definitive chemoradiotherapy for locally advanced esophageal cancer. Outcomes and patterns of failure

    Energy Technology Data Exchange (ETDEWEB)

    Haefner, Matthias Felix; Lang, Kristin; Koerber, Stefan Alexander; Debus, Juergen [University Hospital of Heidelberg, Department of Radiation Oncology, Heidelberg (Germany); National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg (Germany); Verma, Vivek [University of Nebraska Medical Center, Department of Radiation Oncology, Omaha, NE (United States); Uhlmann, Lorenz [University of Heidelberg, Institute of Medical Biometry and Informatics (IMBI), Heidelberg (Germany); Sterzing, Florian [National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg (Germany); Hospital Kempten, Department of Radiation Oncology, Kempten (Germany)

    2018-02-15

    Randomized trials examining neoadjuvant chemoradiotherapy followed by surgical resection (nCRT-S) and definitive CRT (dCRT) for esophageal cancer (EC) patients are hampered by use of nonstandard treatment paradigms. Outcomes of nCRT-S versus dCRT in a more common patient population are lacking. We investigated local control and survival, evaluated clinical factors associated with endpoints, and assessed patterns of failure between these cohorts. We retrospectively analyzed 130 patients with locally advanced EC receiving either dCRT or nCRT-S at our institution from 2000-2012. Inclusion criteria were curatively treated nonmetastatic EC, Karnofsky performance status ≥70%, and receipt of concomitant CRT. Patients were excluded if receiving <41 Gy neoadjuvantly or <50 Gy definitively. Kaplan-Meier analysis was used to evaluate local recurrence (LR), progression-free survival (PFS), and overall survival (OS). Univariate and multivariate Cox proportional hazards modeling addressed factors associated with outcomes. Patterns of failure were enumerated as local, regional, or distant. Mean follow-up was 34.2 months. The 3-year LR was 10.8% in the nCRT-S group and 21.5% in the dCRT group (p = 0.266). Median PFS were 15.6 and 14.9 months, respectively (p = 0.549). Median OS were 20.6 and 25.9 months, respectively (p = 0.81). On univariate and multivariate analysis, none of the investigated factors was associated with outcomes, although node-positive disease showed a trend for worse OS and PFS. Most common failures in both groups were distant (dCRT 31.2% vs. nCRT-S 21.6%) followed by local in-field recurrences (dCRT 26.9% vs. nCRT-S 10.8%). In this institutional analysis, no significant differences regarding outcomes and patterns of failure were observed between nCRT-S and dCRT. (orig.) [German] Randomisierte Studien, welche die neoadjuvante Radiochemotherapie (CRT) einschliesslich konsekutiver Operation (nCRT-S) mit der definitiven Radiochemotherapie (dCRT) fuer

  17. An Overview of Macroprudential Policy Tools

    NARCIS (Netherlands)

    Claessens, S.

    2014-01-01

    Macroprudential policies - caps on loan to value ratios, limits on credit growth and other balance sheets restrictions, (countercyclical) capital and reserve requirements and surcharges, and Pigouvian levies - have become part of the policy paradigm in emerging markets and advanced countries alike.

  18. Left ventricular hypertrophy in renal failure review | Arodiwe ...

    African Journals Online (AJOL)

    Renal failure is becoming increasingly common in our enironment. Advances in management like availability of dialysis and transplantation is prolonging the live of patients. As a consequence complication are increasingly being encountered. Cardiovascular complication is one of the commonest; and left ventricular ...

  19. The cardiorenal link in advanced cirrhosis

    DEFF Research Database (Denmark)

    Krag, Aleksander; Bendtsen, Flemming; Burroughs, Andrew K

    2012-01-01

    A considerable number of patients with advanced cirrhosis develop a hepatorenal syndrome. The pathogenesis involves liver dysfunction, splanchnic vasodilatation, and activation of vasoconstrictive systems. There are now several observations that indicate a relation between the renal failure...... and impaired cardiac function in patients with advanced cirrhosis. Cirrhotic cardiomyopathy has been described as a condition with impaired contractile responsiveness to stress and altered diastolic relaxation. We propose a cardiorenal interaction in patients with advanced cirrhosis and renal dysfunction...

  20. Outcomes of Ahmed glaucoma valve implantation in advanced primary congenital glaucoma with previous surgical failure

    Directory of Open Access Journals (Sweden)

    Huang J

    2015-06-01

    Full Text Available Jingjing Huang,1 Jialiu Lin,1 Ziqiang Wu,2 Hongzhi Xu,3 Chengguo Zuo,1 Jian Ge1 1State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Center for Advanced Eye Care, Carson City, NV, USA; 3Institute of Child Health Policy, University of Florida, Gainesville, FL, USA Purpose: The purpose of this study was to evaluate the intermediate surgical results of Ahmed glaucoma valve (AGV implantation in patients less than 7 years of age, with advanced primary congenital glaucoma who have failed previous surgeries.Patients and methods: Consecutive patients with advanced primary congenital glaucoma that failed previous operations and had undergone subsequent AGV implantation were evaluated retrospectively. Surgical success was defined as 1 intraocular pressure (IOP ≥6 and ≤21 mmHg; 2 IOP reduction of at least 30% relative to preoperative values; and 3 without the need for additional surgical intervention for IOP control, loss of light perception, or serious complications.Results: Fourteen eyes of eleven patients were studied. Preoperatively, the average axial length was 27.71±1.52 (25.56–30.80 mm, corneal diameter was 14.71±1.07 (13.0–16.0 mm, cup-to-disc ratio was 0.95±0.04 (0.9–1.0, and IOP was 39.5±5.7 (30–55 mmHg. The mean follow-up time was 18.29±10.96 (5–44, median 18 months. There were significant reductions in IOPs and the number of glaucoma medications (P<0.001 postoperatively. The IOPs after operation were 11.3±3.4, 13.6±5.1, 16.3±2.7, and 16.1±2.6 mmHg at 1 month, 6 months, 12 months, and 18 months, respectively. Kaplan–Meier estimates of the cumulative probability of valve success were 85.7%, 71.4%, and 71.4% at 6, 12, and 18 months, respectively. Severe surgical complications, including erosion of tube, endophthalmitis, retinal detachment, choroidal detachment, and delayed suprachoroidal hemorrhage, occurred in 28

  1. Advancing Public Policy for High-Growth, Female, and Social Entrepreneurs

    NARCIS (Netherlands)

    Bosma, N.S.|info:eu-repo/dai/nl/182375102; Stam, F.C.|info:eu-repo/dai/nl/215649370; Terjesen, Siri Ann

    2016-01-01

    Findings from a large and growing body of entrepreneurship research offer insights for public policy and public officials and managers. Entrepreneurship policy is defined as measures undertaken to stimulate entrepreneurship in a region or country. The authors discuss generalizations from empirical

  2. Literacy Globalization and the Demand for Cultural Change Policy

    Science.gov (United States)

    Peykani, Mehraban Hadi; Rad, Hadiyeh Tanhaie

    2016-01-01

    Rapid change has faced, information technology and communications world in the last two decades of the new type of illiteracy, failure to comply with the growth of the doctrine of technology on the one hand and lack of attention to retraining and learning. Traditional methods, educational structures, policies and governing policies and…

  3. Failure rate analysis using GLIMMIX

    International Nuclear Information System (INIS)

    Moore, L.M.; Hemphill, G.M.; Martz, H.F.

    1998-01-01

    This paper illustrates use of a recently developed SAS macro, GLIMMIX, for implementing an analysis suggested by Wolfinger and O'Connell (1993) in modeling failure count data with random as well as fixed factor effects. Interest in this software tool arose from consideration of modernizing the Failure Rate Analysis Code (FRAC), developed at Los Alamos National Laboratory in the early 1980's by Martz, Beckman and McInteer (1982). FRAC is a FORTRAN program developed to analyze Poisson distributed failure count data as a log-linear model, possibly with random as well as fixed effects. These statistical modeling assumptions are a special case of generalized linear mixed models, identified as GLMM in the current statistics literature. In the nearly 15 years since FRAC was developed, there have been considerable advances in computing capability, statistical methodology and available statistical software tools allowing worthwhile consideration of the tasks of modernizing FRAC. In this paper, the approaches to GLMM estimation implemented in GLIMMIX and in FRAC are described and a comparison of results for the two approaches is made with data on catastrophic time-dependent pump failures from a report by Martz and Whiteman (1984). Additionally, statistical and graphical model diagnostics are suggested and illustrated with the GLIMMIX analysis results

  4. Innovating innovation Policy. Rethinking green innovation policy in evolutionary perspective

    NARCIS (Netherlands)

    Arentsen, Maarten J.; Dinica, V.; Marquart, N.E.

    1999-01-01

    Advanced environmental standards such as sustainability require substantial improvements in the environmental performances of present technologies. Governments are faced with the challenge to design green innovation policies able to support producers and users of technologies to comply with such

  5. From theory based policy evaluation to SMART Policy Design: Lessons learned from 20 ex-post evaluations of energy efficiency instruments

    International Nuclear Information System (INIS)

    Harmelink, Mirjam; Harmsen, Robert; Nilsson, Lars

    2007-01-01

    This article presents the results of an in-depth ex-post analysis of 20 energy efficiency policy instruments applied across different sectors and countries. Within the AID-EE project, we reconstructed and analysed the implementation process of energy efficiency policy instruments with the aim to identify key factors behind successes and failures. The analysis was performed using a uniform methodology called 'theory based policy evaluation'. With this method the whole implementation process is assessed with the aim to identify: (i) the main hurdles in each step of the implementation process, (ii) key success factors for different types of instruments and (iii) the key indicators that need to be monitored to enable a sound evaluation of the energy efficiency instruments. Our analysis shows that: Energy efficiency policies often lack quantitative targets and clear timeframes; Often policy instruments have multiple and/or unclear objectives; The need for monitoring information does often not have priority in the design phase; For most instruments, monitoring information is collected on a regular basis. However, this information is often insufficient to determine the impact on energy saving, cost-effectiveness and target achievement of an instrument; Monitoring and verification of actual energy savings have a relatively low priority for most of the analyzed instruments. There is no such thing as the 'best' policy instrument. However, typical circumstances in which to apply different types of instruments and generic characteristics that determine success or failure can be identified. Based on the assessments and the experience from applying theory based policy evaluation ex-post, we suggest that this should already be used in the policy formulation and design phase of instruments. We conclude that making policy theory an integral and mandated part of the policy process would facilitate more efficient and effective energy efficiency instruments

  6. Green electricity policies in the Netherlands: an analysis of policy decisions

    International Nuclear Information System (INIS)

    Rooijen, Sascha N.M. van; Wees, Mark T. van

    2006-01-01

    Over the last decades, fundamental changes can be observed in both market conditions and the national policy framework for green electricity in the Netherlands. The Dutch Government has regularly intervened in markets, demonstrating fundamental shifts in policy and approach. This study aims to analyse the developments in renewable energy policy making in the Netherlands. It assesses changes in the choice of policy instruments and target groups, the role of stakeholders, and offers explanations behind policy successes and failures. Dutch green electricity policy over the last decade can be characterised roughly by three phases: in the early 1990s, the government negotiated voluntary agreements with the energy distribution sector on targets for green electricity sales, which were never met. In the second half of the 1990s, a regulatory energy tax was introduced, from which customers of green electricity were exempt. This led to a substantial increase in demand, which was largely met by green electricity imports, and did not lead to additional domestic renewable energy capacity. Finally, a change in policy has taken place recently (2003) shifting the focus from promotion of demand to the promotion of supply through a system of regulated feed-in tariffs. Despite the renewable energy policies, growth of the renewable energy market in the Netherlands has been small and targets have not been fully met. The Dutch government has not yet succeeded in substantially reducing market uncertainties and in building confidence among market parties, because the policies have not been stable and policy objectives have frequently been partly ambiguous. In addition, the influence of stakeholders in renewable energy policy making has been small which has the early acceptance and implementation of alternative policies

  7. Perspectives on bay-delta science and policy

    Science.gov (United States)

    Healey, Michael; Dettinger, Michael; Norgaard, Richard

    2016-01-01

    The State of Bay–Delta Science 2008 highlighted seven emerging perspectives on science and management of the Delta. These perspectives had important effects on policy and legislation concerning management of the Delta ecosystem and water exports. From the collection of papers that make up the State of Bay–Delta Science 2016, we derive another seven perspectives that augment those published in 2008. The new perspectives address nutrient and contaminant concentrations in Delta waters, the failure of the Delta food web to support native species, the role of multiple stressors in driving species toward extinction, and the emerging importance of extreme events in driving change in the ecosystem and the water supply. The scientific advances that underpin these new perspectives were made possible by new measurement and analytic tools. We briefly discuss some of these, including miniaturized acoustic fish tags, sensors for monitoring of water quality, analytic techniques for disaggregating complex contaminant mixtures, remote sensing to assess levee vulnerability, and multidimensional hydrodynamic modeling. Despite these new tools and scientific insights, species conservation objectives for the Delta are not being met. We believe that this lack of progress stems in part from the fact that science and policy do not incorporate sufficiently long-term perspectives. Looking forward half a century was central to the Delta Visioning process, but science and policy have not embraced this conceptual breadth. We are also concerned that protection and enhancement of the unique cultural, recreational, natural resource, and agricultural values of the Delta as an evolving place, as required by the Delta Reform Act, has received no critical study and analysis. Adopting wider and longer science and policy perspectives immediately encourages recognition of the need for evaluation, analysis, and public discourse on novel conservation approaches. These longer and wider perspectives

  8. Perspectives on Bay–Delta Science and Policy

    Directory of Open Access Journals (Sweden)

    Michael Healey

    2016-12-01

    Full Text Available doi: https://doi.org/10.15447/sfews.2016v14iss4art6The State of Bay–Delta Science 2008 highlighted seven emerging perspectives on science and management of the Delta. These perspectives had important effects on policy and legislation concerning management of the Delta ecosystem and water exports. From the collection of papers that make up the State of Bay–Delta Science 2016, we derive another seven perspectives that augment those published in 2008. The new perspectives address nutrient and contaminant concentrations in Delta waters, the failure of the Delta food web to support native species, the role of multiple stressors in driving species toward extinction, and the emerging importance of extreme events in driving change in the ecosystem and the water supply. The scientific advances that underpin these new perspectives were made possible by new measurement and analytic tools. We briefly discuss some of these, including miniaturized acoustic fish tags, sensors for monitoring of water quality, analytic techniques for disaggregating complex contaminant mixtures, remote sensing to assess levee vulnerability, and multidimensional hydrodynamic modeling. Despite these new tools and scientific insights, species conservation objectives for the Delta are not being met. We believe that this lack of progress stems in part from the fact that science and policy do not incorporate sufficiently long-term perspectives. Looking forward half a century was central to the Delta Visioning process, but science and policy have not embraced this conceptual breadth. We are also concerned that protection and enhancement of the unique cultural, recreational, natural resource, and agricultural values of the Delta as an evolving place, as required by the Delta Reform Act, has received no critical study and analysis. Adopting wider and longer science and policy perspectives immediately encourages recognition of the need for evaluation, analysis, and public discourse on

  9. Atrial Fibrillation and Heart Failure - Cause or Effect?

    Science.gov (United States)

    Prabhu, Sandeep; Voskoboinik, Aleksandr; Kaye, David M; Kistler, Peter M

    2017-09-01

    There are emerging epidemics of atrial fibrillation (AF) and heart failure in most developed countries, with a significant health burden. Due to many shared pathophysiological mechanisms, which facilitate the maintenance of each condition, AF and heart failure co-exist in up to 30% of patients. In the circumstance where known structural causes of heart failure (such as myocardial infarction) are absent, patients presenting with both conditions present a unique challenge, particularly as the temporal relationship of each condition can often remain elusive from the clinical history. The question of whether the AF is driving, or significantly contributing to the left ventricular (LV) dysfunction, rather than merely a consequence of heart failure, has become ever more pertinent, especially as catheter ablation now offers a significant advancement over existing rhythm control strategies. This paper will review the inter-related physiological drivers of AF and heart failure before considering the implications from the outcomes of recent clinical trials in patients with AF and heart failure. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  10. Running code as part of an open standards policy

    OpenAIRE

    Shah, Rajiv; Kesan, Jay

    2009-01-01

    Governments around the world are considering implementing or even mandating open standards policies. They believe these policies will provide economic, socio-political, and technical benefits. In this article, we analyze the failure of the Massachusetts’s open standards policy as applied to document formats. We argue it failed due to the lack of running code. Running code refers to multiple independent, interoperable implementations of an open standard. With running code, users have choice ...

  11. 16 CFR 1012.1 - General policy considerations; scope.

    Science.gov (United States)

    2010-01-01

    ... Policy, sets forth requirements for advance public notice, public attendance, and recordkeeping for... 16 Commercial Practices 2 2010-01-01 2010-01-01 false General policy considerations; scope. 1012.1 Section 1012.1 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL MEETINGS POLICY-MEETINGS...

  12. Public policy perspective on groundwater quality

    International Nuclear Information System (INIS)

    Libby, L.W.

    1990-01-01

    Groundwater pollution problems are fundamentally institutional problems. The means for reducing contamination are institutional: the mix of incentives, rights and obligations confronting resource users. Only changes in the rights and obligations of users or the economic and social cost of water use options will reduce groundwater pollution. Policy is the process by which those changes are made. The essential purpose of groundwater quality policy is to change water use behavior. For the most part, people do respond to evidence that a failure to change could be painful. New information can produce the support necessary for regulation or other policy change. It is essential to maintain healthy respect for the rights and intentions of individuals. Improved understanding of human behavior is essential to success in groundwater policy

  13. Antiretroviral drug regimens to prevent mother-to-child transmission of HIV: a review of scientific, program, and policy advances for sub-Saharan Africa.

    Science.gov (United States)

    Chi, Benjamin H; Stringer, Jeffrey S A; Moodley, Dhayendre

    2013-06-01

    Considerable advances have been made in the effort to prevent mother-to-child HIV transmission (PMTCT) in sub-Saharan Africa. Clinical trials have demonstrated the efficacy of antiretroviral regimens to interrupt HIV transmission through the antenatal, intrapartum, and postnatal periods. Scientific discoveries have been rapidly translated into health policy, bolstered by substantial investment in health infrastructure capable of delivering increasingly complex services. A new scientific agenda is also emerging, one that is focused on the challenges of effective and sustainable program implementation. Finally, global campaigns to "virtually eliminate" pediatric HIV and dramatically reduce HIV-related maternal mortality have mobilized new resources and renewed political will. Each of these developments marks a major step in regional PMTCT efforts; their convergence signals a time of rapid progress in the field, characterized by an increased interdependency between clinical research, program implementation, and policy. In this review, we take stock of recent advances across each of these areas, highlighting the challenges--and opportunities--of improving health services for HIV-infected mothers and their children across the region.

  14. The Hinkley Point decision: An analysis of the policy process

    International Nuclear Information System (INIS)

    Thomas, Stephen

    2016-01-01

    In 2006, the British government launched a policy to build nuclear power reactors based on a claim that the power produced would be competitive with fossil fuel and would require no public subsidy. A decade later, it is not clear how many, if any, orders will be placed and the claims on costs and subsidies have proved false. Despite this failure to deliver, the policy is still being pursued with undiminished determination. The finance model that is now proposed is seen as a model other European countries can follow so the success or otherwise of the British nuclear programme will have implications outside the UK. This paper contends that the checks and balances that should weed out misguided policies, have failed. It argues that the most serious failure is with the civil service and its inability to provide politicians with high quality advice – truth to power. It concludes that the failure is likely to be due to the unwillingness of politicians to listen to opinions that conflict with their beliefs. Other weaknesses include the lack of energy expertise in the media, the unwillingness of the public to engage in the policy process and the impotence of Parliamentary Committees. - Highlights: •Britain's nuclear power policy is failing due to high costs and problems of finance. •This has implications for European countries who want to use the same financing model. •The continued pursuit of a failing policy is due to poor advice from civil servants. •Lack of expertise in the media and lack of public engagement have contributed. •Parliamentary processes have not provided proper critical scrutiny.

  15. Dispersed trading and the prevention of market failure

    DEFF Research Database (Denmark)

    Porter, David C.; Tanggaard, Carsten; Weaver, Daniel G.

    2008-01-01

    With augmented demands on power grids resulting in longer and larger blackouts combined with heightened concerns of terrorist attacks, trading institutions and policy makers have widened their search for systems that avoid market failure during these disturbing events. We provide insight...... into this issue by examining trading behaviour at the Copenhagen Stock Exchange during a major blackout. We find that although market quality declined, markets remained functional and some price discovery occurred during the blackout period suggesting that the NOREX structure of interlinked trading systems...... combined with widely dispersed trading locations may be a viable means of protection against market failure during massive power disruptions or terrorist attacks....

  16. Development and application of a probabilistic evaluation method for advanced process technologies

    Energy Technology Data Exchange (ETDEWEB)

    Frey, H.C.; Rubin, E.S.

    1991-04-01

    The objective of this work is to develop and apply a method for research planning for advanced process technologies. To satisfy requirements for research planning, it is necessary to: (1) identify robust solutions to process design questions in the face of uncertainty to eliminate inferior design options; (2) identify key problem areas in a technology that should be the focus of further research to reduce the risk of technology failure; (3) compare competing technologies on a consistent basis to determine the risks associated with adopting a new technology; and (4) evaluate the effects that additional research might have on comparisons with conventional technology. An important class of process technologies are electric power plants. In particular, advanced clean coal technologies are expected to play a key role in the energy and environmental future of the US, as well as in other countries. Research planning for advanced clean coal technology development is an important part of energy and environmental policy. Thus, the research planning method developed here is applied to case studies focusing on a specific clean coal technology. The purpose of the case studies is both to demonstrate the research planning method and to obtain technology-specific conclusions regarding research strategies.

  17. Korea's Post-Crisis Monetary Policy Reforms

    OpenAIRE

    Donghyun Park; Junggun Oh

    2005-01-01

    Korea's financial crisis of 1997–1998 was brought about by the unsustainable combination of large capital inflows and an inefficient financial system. The Bank of Korea contributed to the crisis primarily through its failures as the regulator of the financial system rather than as the conductor of monetary policy. Our paper explores the role of the two major monetary policy reforms Korea has implemented in response to the crisis — the establishment of a new financial regulator and the adoptio...

  18. Development of National Technology Audit Policy

    OpenAIRE

    Subiyanto Subiyanto

    2017-01-01

    The Laws have mandated implementation of technology audit, nevertheless such implementation needs an additional policy that is more technical. The concept of national audit technology policy shall make technology audit as a tool to ensure the benefit of technology application for society and technology advance for nation independency. This article discusses on technology audit policy concept especially infrastructure requirement, with emphasis on regulation, implementation tools, and related ...

  19. Recruit and ADVANCE

    Science.gov (United States)

    Rosser, Sue V.

    2007-04-01

    Beginning in 2001, the National Science Foundation launched the ADVANCE Initiative, which has now awarded more than 70 million to some thirty institutions for transformations to advance women. Results of studies on how to attract and retain women students and faculty underpinned our ADVANCE Institutional Transformation grant funded by the NSF for 3.7 million for five years, beginning in 2001. As co-principal investigator on this grant, I insured that this research informed the five major threads of the grant: 1) Four termed ADVANCE professors to mentor junior women faculty in each college; 2) Collection of MIT-Report-like data indicators to assess whether advancement of women really occurs during and after the institutional transformation undertaken through ADVANCE; 3) Family-friendly policies and practices to stop the tenure clock and provide active service, modified duties, lactation stations and day care; 4) Mini-retreats to facilitate access for tenure-track women faculty to male decision-makers and administrators for informal conversations and discussion on topics important to women faculty; 5) Removal of subtle gender, racial, and other biases in promotion and tenure. The dynamic changes resulting from the grant in quality of mentoring, new understanding of promotion and tenure, numbers of women retained and given endowed chairs, and emergence of new family friendly policies gave me hope for genuine diversification of leadership in science and technology. As the grant funding ends, the absence of NSF prestige and monitoring, coupled with a change in academic leadership at the top, provide new challenges for institutionalization, recruitment, and advancement of women into leadership positions in science and engineering.

  20. Stimulating learning-by-doing in advanced biofuels: effectiveness of alternative policies

    International Nuclear Information System (INIS)

    Chen Xiaoguang; Khanna, Madhu; Yeh, Sonia

    2012-01-01

    This letter examines the effectiveness of various biofuel and climate policies in reducing future processing costs of cellulosic biofuels due to learning-by-doing. These policies include a biofuel production mandate alone and supplementing the biofuel mandate with other policies, namely a national low carbon fuel standard, a cellulosic biofuel production tax credit or a carbon price policy. We find that the binding biofuel targets considered here can reduce the unit processing cost of cellulosic ethanol by about 30% to 70% between 2015 and 2035 depending on the assumptions about learning rates and initial costs of biofuel production. The cost in 2035 is more sensitive to the speed with which learning occurs and less sensitive to uncertainty in the initial production cost. With learning rates of 5–10%, cellulosic biofuels will still be at least 40% more expensive than liquid fossil fuels in 2035. The addition of supplementary low carbon/tax credit policies to the mandate that enhance incentives for cellulosic biofuels can achieve similar reductions in these costs several years earlier than the mandate alone; the extent of these incentives differs across policies and different kinds of cellulosic biofuels. (letter)

  1. Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us

    Directory of Open Access Journals (Sweden)

    Erik Fung

    2018-04-01

    Full Text Available Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management.

  2. A holistic approach to managing a patient with heart failure.

    Science.gov (United States)

    Duncan, Alison; Cunnington, Colin

    2013-03-01

    Despite varied and complex therapeutic strategies for managing patients with heart failure, the prognosis may remain poor in certain groups. Recognition that patients with heart failure frequently require input from many care groups formed the basis of The British Society of Heart Failure Annual Autumn Meeting in London (UK), in November 2012, entitled: 'Heart failure: a multidisciplinary approach'. Experts in cardiology, cardiac surgery, general practice, care of the elderly, palliative care and cardiac imaging shared their knowledge and expertise. The 2-day symposium was attended by over 500 participants from the UK, Europe and North America, and hosted physicians, nurses, scientists, trainees and representatives from the industry, as well as patient and community groups. The symposium, accredited by the Royal College of Physicians and the Royal College of Nursing, focused on the multidisciplinary approach to heart failure, in particular, current therapeutic advances, cardiac remodeling, palliative care, atrial fibrillation, heart rate-lowering therapies, management of acute heart failure and the management of patients with mitral regurgitation and heart failure.

  3. The Seduction of the Subject/Citizen: Governmentality and School Governance Policy.

    Science.gov (United States)

    Spencer, Brenda L.

    Traditional educational policy analysis is typically evaluative, focusing on degrees of success or failure, often obscuring how particular forms of knowledge and power reproduce social inequity. A Foucauldian, postmodern framework is particularly appropriate for analyzing educational policy because, in part, the Foucauldian concepts of…

  4. Failures of the national policy for sustainable development of Bulgaria – economic dimensions

    OpenAIRE

    Nozharov, Shteryo; Koralova, Petya

    2017-01-01

    Bulgaria is a member of the EU since 2007. The country has issues with its economic policy, which issues could have negative impact over the EU’s policies as a whole. When the economic policy of a Member State is blemished by a systematic strategic misconceptions, it is necessary this to be analysed in depth. The debate, about the future of the EU after Brexit and the concept about multi-speed Europe is consequence of the efficiency of the economic and political systems in each individual Mem...

  5. Identification of failure type in corroded pipelines: a bayesian probabilistic approach.

    Science.gov (United States)

    Breton, T; Sanchez-Gheno, J C; Alamilla, J L; Alvarez-Ramirez, J

    2010-07-15

    Spillover of hazardous materials from transport pipelines can lead to catastrophic events with serious and dangerous environmental impact, potential fire events and human fatalities. The problem is more serious for large pipelines when the construction material is under environmental corrosion conditions, as in the petroleum and gas industries. In this way, predictive models can provide a suitable framework for risk evaluation, maintenance policies and substitution procedure design that should be oriented to reduce increased hazards. This work proposes a bayesian probabilistic approach to identify and predict the type of failure (leakage or rupture) for steel pipelines under realistic corroding conditions. In the first step of the modeling process, the mechanical performance of the pipe is considered for establishing conditions under which either leakage or rupture failure can occur. In the second step, experimental burst tests are used to introduce a mean probabilistic boundary defining a region where the type of failure is uncertain. In the boundary vicinity, the failure discrimination is carried out with a probabilistic model where the events are considered as random variables. In turn, the model parameters are estimated with available experimental data and contrasted with a real catastrophic event, showing good discrimination capacity. The results are discussed in terms of policies oriented to inspection and maintenance of large-size pipelines in the oil and gas industry. 2010 Elsevier B.V. All rights reserved.

  6. The application of contrast explanation to energy policy research: UK nuclear energy policy 2002–2012

    International Nuclear Information System (INIS)

    Heffron, Raphael J.

    2013-01-01

    This paper advances the application of the methodology, contrast explanation, to energy policy research. Research in energy policy is complex and often involves inter-disciplinary work, which traditional economic methodologies fail to capture. Consequently, the more encompassing methodology of contrast explanation is assessed and its use in other social science disciplines explored in brief. It is then applied to an energy policy research topic—in this case, nuclear energy policy research in the UK. Contrast explanation facilitates research into policy and decision-making processes in energy studies and offers an alternative to the traditional economic methods used in energy research. Further, contrast explanation is extended by the addition of contested and uncontested hypotheses analyses. This research focuses on the methods employed to deliver the new nuclear programme of the UK government. In order to achieve a sustainable nuclear energy policy three issues are of major importance: (1) law, policy and development; (2) public administration; and (3) project management. Further, the research identifies that policy in the area remains to be resolved, in particular at an institutional and legal level. However, contrary to the literature, in some areas, the research identifies a change of course as the UK concentrates on delivering a long-term policy for the nuclear energy sector and the overall energy sector. - Highlights: ► Energy policy research is interdisciplinary and needs additional methodological approaches. ► New method of contrast explanation advanced for energy policy research. ► This methodology is based on dialectical learning which examines conflict between sources of data. ► Research example used here is of UK nuclear energy policy. ► Major issues in UK nuclear energy policy are planning law, public administration, and project management

  7. Public and state responses to high-level nuclear waste disposal: Learning from policy failure

    International Nuclear Information System (INIS)

    Kraft, M.E.

    1991-01-01

    Nuclear waste policy in the United States has faded in large part because of public and state opposition to repository siting. However, that outcome was not inevitable. This paper argues that better policy design and greater attention to the crucial tasks of policy legitimation both by the U.S. Congress and by the Department of Energy might have significantly increased the chances for successful implementation. Even though the program now has a highly uncertain future, suggestions are offered for policy learning and change that may increase the probability of success

  8. Shaping Policy Change in Population Health: Policy Entrepreneurs, Ideas, and Institutions.

    Science.gov (United States)

    Béland, Daniel; Katapally, Tarun R

    2018-01-14

    Political realities and institutional structures are often ignored when gathering evidence to influence population health policies. If these policies are to be successful, social science literature on policy change should be integrated into the population health approach. In this contribution, drawing on the work of John W. Kingdon and related scholarship, we set out to examine how key components of the policy change literature could contribute towards the effective development of population health policies. Shaping policy change would require a realignment of the existing school of thought, where the contribution of population health seems to end at knowledge translation. Through our critical analysis of selected literature, we extend recommendations to advance a burgeoning discussion in adopting new approaches to successfully implement evidence-informed population health policies. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  9. Advancing the Field Elder Abuse: Future Directions and Policy Implications

    Science.gov (United States)

    Dong, XinQi

    2012-01-01

    Elder abuse, sometime called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse, neglect (caregiver neglect and self-neglect), and financial exploitation. Evidence suggests that 1 out of 10 older adult experiences some form of elder abuse, and only 1 of out 25 cases are actually reported to social services agencies. At the same time, elder abuse is associated with significant morbidity and premature mortality. Despite these findings, there is a great paucity in research, practice, and policy dealing with the pervasive issues of elder abuse. Through my experiences as a American Political Sciences Association Congressional Policy Fellow/Health and Aging Policy Fellow working with Administration on Community Living (ACL) (Previously known at Administration on Aging (AoA)) for the last two years, I will describe the major functions of the ACL; and highlight on two major pieces of federal legislation: The Older Americans Act (OAA) and the Elder Justice Act (EJA). Moreover, I will highlight major research gaps and future policy relevant research directions for the field of elder abuse. PMID:23110488

  10. Treatment of respiratory failure in COPD

    Directory of Open Access Journals (Sweden)

    Stephan Budweiser

    2008-12-01

    Full Text Available Stephan Budweiser1, Rudolf A Jörres2, Michael Pfeifer1,31Center for Pneumology, Hospital Donaustauf, Donaustauf, Germany; 2Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany; 3Department of Internal Medicine II, Division of Respirology, University of Regensburg, Regensburg, GermanyAbstract: Patients with advanced COPD and acute or chronic respiratory failure are at high risk for death. Beyond pharmacological treatment, supplemental oxygen and mechanical ventilation are major treatment options. This review describes the physiological concepts underlying respiratory failure and its therapy, as well as important treatment outcomes. The rationale for the controlled supply of oxygen in acute hypoxic respiratory failure is undisputed. There is also a clear survival benefit from long-term oxygen therapy in patients with chronic hypoxia, while in mild, nocturnal, or exercise-induced hypoxemia such long-term benefits appear questionable. Furthermore, much evidence supports the use of non-invasive positive pressure ventilation in acute hypercapnic respiratory failure. It application reduces intubation and mortality rates, and the duration of intensive care unit or hospital stays, particularly in the presence of mild to moderate respiratory acidosis. COPD with chronic hypercapnic respiratory failure became a major indication for domiciliary mechanical ventilation, based on pathophysiological reasoning and on data regarding symptoms and quality of life. Still, however, its relevance for long-term survival has to be substantiated in prospective controlled studies. Such studies might preferentially recruit patients with repeated hypercapnic decompensation or a high risk for death, while ensuring effective ventilation and the patients’ adherence to therapy.Keywords: respiratory failure, COPD, mechanical ventilation, non-invasive ventilation long-term oxygen therapy, chronic

  11. Advanced TCA Backplane Tester

    CERN Document Server

    Oltean, Alexandra Dana

    2004-01-01

    At the beginning of 2003, the PICMG group adopted the AdvancedTCA (Advanced Telecom Computing Architecture) standard. The 10Gb/s backplane of the AdvancedTCA chassis is well specified in the standard but it remains however a high end product, which can be itself subject to printed circuit board manufacturing control problems that could greatly affect its quality control. In order to study the practical aspects of high speed Ethernet switching at 10Gb/s and to validate the signal integrity of the AdvancedTCA backplane, we developed a Backplane Tester. The tester system is able of running monitored PRBS traffic at 3.125Gb/s over every link on the AdvancedTCA backplane simultaneously and to monitor any possible connectivity failure immediately in terms of link and slot position inside the chassis. The present report presents the architectural hardware design, the control structure and software aspects of the AdvancedTCA Backplane Tester design.

  12. On rate-state and Coulomb failure models

    Science.gov (United States)

    Gomberg, J.; Beeler, N.; Blanpied, M.

    2000-01-01

    We examine the predictions of Coulomb failure stress and rate-state frictional models. We study the change in failure time (clock advance) Δt due to stress step perturbations (i.e., coseismic static stress increases) added to "background" stressing at a constant rate (i.e., tectonic loading) at time t0. The predictability of Δt implies a predictable change in seismicity rate r(t)/r0, testable using earthquake catalogs, where r0 is the constant rate resulting from tectonic stressing. Models of r(t)/r0, consistent with general properties of aftershock sequences, must predict an Omori law seismicity decay rate, a sequence duration that is less than a few percent of the mainshock cycle time and a return directly to the background rate. A Coulomb model requires that a fault remains locked during loading, that failure occur instantaneously, and that Δt is independent of t0. These characteristics imply an instantaneous infinite seismicity rate increase of zero duration. Numerical calculations of r(t)/r0 for different state evolution laws show that aftershocks occur on faults extremely close to failure at the mainshock origin time, that these faults must be "Coulomb-like," and that the slip evolution law can be precluded. Real aftershock population characteristics also may constrain rate-state constitutive parameters; a may be lower than laboratory values, the stiffness may be high, and/or normal stress may be lower than lithostatic. We also compare Coulomb and rate-state models theoretically. Rate-state model fault behavior becomes more Coulomb-like as constitutive parameter a decreases relative to parameter b. This is because the slip initially decelerates, representing an initial healing of fault contacts. The deceleration is more pronounced for smaller a, more closely simulating a locked fault. Even when the rate-state Δt has Coulomb characteristics, its magnitude may differ by some constant dependent on b. In this case, a rate-state model behaves like a modified

  13. Modeling and optimizing periodically inspected software rejuvenation policy based on geometric sequences

    International Nuclear Information System (INIS)

    Meng, Haining; Liu, Jianjun; Hei, Xinhong

    2015-01-01

    Software aging is characterized by an increasing failure rate, progressive performance degradation and even a sudden crash in a long-running software system. Software rejuvenation is an effective method to counteract software aging. A periodically inspected rejuvenation policy for software systems is studied. The consecutive inspection intervals are assumed to be a decreasing geometric sequence, and upon the inspection times of software system and its failure features, software rejuvenation or system recovery is performed. The system availability function and cost rate function are obtained, and the optimal inspection time and rejuvenation interval are both derived to maximize system availability and minimize cost rate. Then, boundary conditions of the optimal rejuvenation policy are deduced. Finally, the numeric experiment result shows the effectiveness of the proposed policy. Further compared with the existing software rejuvenation policy, the new policy has higher system availability. - Highlights: • A periodically inspected rejuvenation policy for software systems is studied. • A decreasing geometric sequence is used to denote the consecutive inspection intervals. • The optimal inspection times and rejuvenation interval are found. • The new policy is capable of reducing average cost and improving system availability

  14. Multidisciplinary approach for in-deep assessment of joint prosthesis failure.

    Science.gov (United States)

    Tessarolo, F; Caola, I; Piccoli, F; Dorigotti, P; Demattè, E; Molinari, M; Malavolta, M; Barbareschi, M; Caciagli, P; Nollo, G

    2009-01-01

    In spite of advancement in biomaterials and biomechanics, in development of new osteo-integrative materials and coatings, and in macro- micro- component design, a non negligible fraction of the implanted prosthesis fails before the expected lifetime. A prospective observational clinical study has been conducted to define and apply a set of experimental techniques to in-deep assess the failure of joint prosthesis. Microbiological, histological and micro-structural techniques were implemented to specifically address phenomena occurring at the tissue-implant interface. Results obtained from 27 cases of prosthetic joint failure are discussed in terms of sensitivity and specificity. A procedural flow-chart is finally proposed for the assessment of joint prosthesis failure.

  15. Advancing Evidence Based Policymaking and Regulation to Ensure ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Advancing Evidence Based Policymaking and Regulation to Ensure Greater ... which is Communications Policy Research South (CPRsouth), a yearly conference that ... policy intellectuals through tutorials for young scholars and internships.

  16. Vocational Education and Training: A Major Shift in World Bank Policy.

    Science.gov (United States)

    Foster, Phillip

    1992-01-01

    Comments on the World Bank's policy paper on vocational and technical education and training. Argues that past failures in establishing effective vocational and technical education were a result of not applying conventional neoclassical economic theory. Asserts that the World Bank's policy paper corrects this approach. (CFR)

  17. Policy issues inherent in advanced technology development

    Energy Technology Data Exchange (ETDEWEB)

    Baumann, P.D.

    1994-12-31

    In the development of advanced technologies, there are several forces which are involved in the success of the development of those technologies. In the overall development of new technologies, a sufficient number of these forces must be present and working in order to have a successful opportunity at developing, introducing and integrating into the marketplace a new technology. This paper discusses some of these forces and how they enter into the equation for success in advanced technology research, development, demonstration, commercialization and deployment. This paper limits itself to programs which are generally governmental funded, which in essence represent most of the technology development efforts that provide defense, energy and environmental technological products. Along with the identification of these forces are some suggestions as to how changes may be brought about to better ensure success in a long term to attempt to minimize time and financial losses.

  18. Policy issues inherent in advanced technology development

    International Nuclear Information System (INIS)

    Baumann, P.D.

    1994-01-01

    In the development of advanced technologies, there are several forces which are involved in the success of the development of those technologies. In the overall development of new technologies, a sufficient number of these forces must be present and working in order to have a successful opportunity at developing, introducing and integrating into the marketplace a new technology. This paper discusses some of these forces and how they enter into the equation for success in advanced technology research, development, demonstration, commercialization and deployment. This paper limits itself to programs which are generally governmental funded, which in essence represent most of the technology development efforts that provide defense, energy and environmental technological products. Along with the identification of these forces are some suggestions as to how changes may be brought about to better ensure success in a long term to attempt to minimize time and financial losses

  19. Intravenous Milrinone Infusion Improves Congestive Heart Failure Caused by Diastolic Dysfunction

    Science.gov (United States)

    Albrecht, Carlos A.; Giesler, Gregory M.; Kar, Biswajit; Hariharan, Ramesh; Delgado, Reynolds M.

    2005-01-01

    Although there have been significant advances in the medical treatment of heart failure patients with impaired systolic function, very little is known about the diagnosis and treatment of diastolic dysfunction. We report the cases of 3 patients in New York Heart Association functional class IV who had echocardiographically documented diastolic dysfunction as the main cause of heart failure. All 3 patients received medical therapy with long-term milrinone infusion. PMID:16107121

  20. 2011 State Teacher Policy Yearbook. Hawaii

    Science.gov (United States)

    National Council on Teacher Quality, 2011

    2011-01-01

    For five years running, the National Council on Teacher Quality (NCTQ) has tracked states' teacher policies, preparing a detailed and thorough compendium of teacher policy in the United States on topics related to teacher preparation, licensure, evaluation, career advancement, tenure, compensation, pensions and dismissal. The 2011 State Teacher…

  1. For a cyberspace information policy: advances, perspectives and challenges

    Directory of Open Access Journals (Sweden)

    Jakeline Amparo Villota Enríquez

    2017-06-01

    Full Text Available This article is to describe and analyze the policies of information in cyberspace, both global and regionally, in different directions: programs, resolutions, and projects from the information sector. Likewise, an overview of the same is presented in the Latin American and Caribbean region. Through documentary analysis of the literature related to the topic, the article is based on a review of literature raised from scientific materials such as: books, thesis papers, dissertations, texts on internet sites and articles, resolutions, projects and decrees dealing with the same topic. As a result, cyberspace is conceptualized and its elements, dimensions, strategies and variations are characterized, by analyzing the information from cyberspace policy, based on the global stage to relate it, finally, to the region of Latin America and the Caribbean, with the idea of better addressing the problems. The cyberspace information policy experience a minor and slow process in the field of cyber war; resulting from the obstacle of international cooperation defined by the disparate ambitions of the State or region.

  2. Security and policy driven computing

    CERN Document Server

    Liu, Lei

    2010-01-01

    Security and Policy Driven Computing covers recent advances in security, storage, parallelization, and computing as well as applications. The author incorporates a wealth of analysis, including studies on intrusion detection and key management, computer storage policy, and transactional management.The book first describes multiple variables and index structure derivation for high dimensional data distribution and applies numeric methods to proposed search methods. It also focuses on discovering relations, logic, and knowledge for policy management. To manage performance, the text discusses con

  3. Echocardiographic assessment of right ventricular function in routine practice: Which parameters are useful to predict one-year outcome in advanced heart failure patients with dilated cardiomyopathy?

    Science.gov (United States)

    Kawata, Takayuki; Daimon, Masao; Kimura, Koichi; Nakao, Tomoko; Lee, Seitetsu L; Hirokawa, Megumi; Kato, Tomoko S; Watanabe, Masafumi; Yatomi, Yutaka; Komuro, Issei

    2017-10-01

    Right ventricular (RV) function has recently gained attention as a prognostic predictor of outcome even in patients who have left-sided heart failure. Since several conventional echocardiographic parameters of RV systolic function have been proposed, our aim was to determine if any of these parameters (tricuspid annular plane systolic excursion: TAPSE, tissue Doppler derived systolic tricuspid annular motion velocity: S', fractional area change: FAC) are associated with outcome in advanced heart failure patients with dilated cardiomyopathy (DCM). We retrospectively enrolled 68 DCM patients, who were New York Heart Association (NYHA) Class III or IV and had a left ventricular (LV) ejection fraction functional class IV, plasma brain natriuretic peptide concentration, intravenous inotrope use, left atrial volume index, and FAC were associated with outcome, whereas TAPSE and S' were not. Receiver-operating characteristic curve analysis showed that the optimal FAC cut-off value to identify patients with an event was rights reserved.

  4. Analysis of dependent failures in risk assessment and reliability evaluation

    International Nuclear Information System (INIS)

    Fleming, K.N.; Mosleh, A.; Kelley, A.P. Jr.; Gas-Cooled Reactors Associates, La Jolla, CA)

    1983-01-01

    The ability to estimate the risk of potential reactor accidents is largely determined by the ability to analyze statistically dependent multiple failures. The importance of dependent failures has been indicated in recent probabilistic risk assessment (PRA) studies as well as in reports of reactor operating experiences. This article highlights the importance of several different types of dependent failures from the perspective of the risk and reliability analyst and provides references to the methods and data available for their analysis. In addition to describing the current state of the art, some recent advances, pitfalls, misconceptions, and limitations of some approaches to dependent failure analysis are addressed. A summary is included of the discourse on this subject, which is presented in the Institute of Electrical and Electronics Engineers/American Nuclear Society PRA Procedures Guide

  5. [Refractory heart failure. Models of hospital, ambulatory, and home management].

    Science.gov (United States)

    Oliva, Fabrizio; Alunni, Gianfranco

    2002-08-01

    Chronic heart failure is an enormous and growing public health problem and is reaching epidemic proportions. Its economic impact is dramatic; two thirds of expenses are for hospitalizations and relatively little is being spent for medications and outpatient visits. Most of the hospitalizations, deaths and costs are incurred by a relatively small minority of patients who may be described as having "complex", "advanced", "refractory" or "end-stage" heart failure; however, in essence they are patients who have severe symptoms and/or recurrent hospitalizations and/or emergency department visits despite maximal oral therapy. Many of the recommendations regarding the management of these patients are based more on experience than on evidence from controlled trials. This, because such patients require an individualized therapy which limits their inclusion in large trials and because support is less easily available when testing specific strategies than when testing specific agents. Improving the treatment of this group of patients by optimizing their medical regimen, aggressive monitoring and providing early intervention to avert heart failure can reduce their morbidity, mortality and costs of care. Refractory heart failure is not a single disease and it is extremely unlikely that all patients should be treated in a similar manner; before selecting the appropriate therapy, the clinician must categorize and profile the patient. The first step should be a re-evaluation of the previous treatment because many patients are treated suboptimally. It is also important to identify reversible or precipitating factors. For patients with advanced heart failure, the initial goal of therapy is to improve symptoms; the next goal is to maintain the improvement and to prevent later deterioration. The appropriate treatment plan will reflect the presence of comorbidities, the patients' history regarding previous responses to therapy, their own expectations with regard to daily life. The most

  6. Left ventricular assist device management in patients chronically supported for advanced heart failure.

    Science.gov (United States)

    Cowger, Jennifer; Romano, Matthew A; Stulak, John; Pagani, Francis D; Aaronson, Keith D

    2011-03-01

    This review summarizes management strategies to reduce morbidity and mortality in heart failure patients supported chronically with implantable left ventricular assist devices (LVADs). As the population of patients supported with long-term LVADs has grown, patient selection, operative technique, and patient management strategies have been refined, leading to improved outcomes. This review summarizes recent findings on LVAD candidate selection, and discusses outpatient strategies to optimize device performance and heart failure management. It also reviews important device complications that warrant close outpatient monitoring. Managing patients on chronic LVAD support requires regular patient follow-up, multidisciplinary care teams, and frequent laboratory and echocardiographic surveillance to ensure optimal outcomes.

  7. From Grenelle to Bali: advances, uncertainties, contradictions and perspectives

    International Nuclear Information System (INIS)

    2008-01-01

    The contributions propose an assessment and critical comments of the content and of the implementation of the Grenelle de l'Environnement in France. The authors outline the advances in the difficult political context, criticize a conservative strategy and a dogmatic vision which will lead us to failure, suggest an equivalent to the Grenelle de l'Environnement but focused on citizen participation, and discuss the challenge of democratic governance. Thy also outline the quality of the Grenelle de l'Environnement in the global context and comments the place given to climate change. They comment the main weaknesses identified in the Grenelle de l'Environnement: the nuclear issue, the methane issue (the importance of methane in global warming, the consequences of its systematic underestimation in policies of struggle against climate change). The last contributions are dealing with the Bali conference to come, its price for success and the carbon market in front of atmosphere physics realities

  8. Detecting failure of climate predictions

    Science.gov (United States)

    Runge, Michael C.; Stroeve, Julienne C.; Barrett, Andrew P.; McDonald-Madden, Eve

    2016-01-01

    The practical consequences of climate change challenge society to formulate responses that are more suited to achieving long-term objectives, even if those responses have to be made in the face of uncertainty1, 2. Such a decision-analytic focus uses the products of climate science as probabilistic predictions about the effects of management policies3. Here we present methods to detect when climate predictions are failing to capture the system dynamics. For a single model, we measure goodness of fit based on the empirical distribution function, and define failure when the distribution of observed values significantly diverges from the modelled distribution. For a set of models, the same statistic can be used to provide relative weights for the individual models, and we define failure when there is no linear weighting of the ensemble models that produces a satisfactory match to the observations. Early detection of failure of a set of predictions is important for improving model predictions and the decisions based on them. We show that these methods would have detected a range shift in northern pintail 20 years before it was actually discovered, and are increasingly giving more weight to those climate models that forecast a September ice-free Arctic by 2055.

  9. The research on the failure regularity of GM counter tubes

    International Nuclear Information System (INIS)

    Li Jiyuan; Huai Guangli; Xie Bo; Zhang Hao

    2002-01-01

    The reliability of GM counter tubes should be described by useful time before failure-life and failure rate during life. A new method to study the failure regularity of GM counter tubes is advanced and adopted. The essential point of the method is that after the GM counter tubes of the instruments in use is tested, both the performance parameters and other information of the GM counter tubes and the instruments collected are recorded. Then database is created. Failure criterion is ascertained. The GM counter tubes are inspected to determine whether they are failure. Failure mode should be decided if the GM counter tubes failure. The GM counter tubes with the same useful year come together to make up a subsample. According to the relevant information, the number of the subsample is restored to the number of the sample that initially put into use. Then the number of failure sample is counted and at the same time the distribution of failure mode is got. The parameter m, γ, t 0 of Weibull distribution function are calculated with method of linear fit. Thus mean life, failure rate and other character values are obtained. Using this method, useful life and failure rate are determined. The conclusion is that the useful life is 18-20 years and the failure rate is 5 x 10 -6 and 4 x 10 -6 /h respectively during the course

  10. The embodiment of success and failure as forward versus backward movements.

    Science.gov (United States)

    Robinson, Michael D; Fetterman, Adam K

    2015-01-01

    People often speak of success (e.g., "advance") and failure (e.g., "setback") as if they were forward versus backward movements through space. Two experiments sought to examine whether grounded associations of this type influence motor behavior. In Experiment 1, participants categorized success versus failure words by moving a joystick forward or backward. Failure categorizations were faster when moving backward, whereas success categorizations were faster when moving forward. Experiment 2 removed the requirement to categorize stimuli and used a word rehearsal task instead. Even without Experiment 1's response procedures, a similar cross-over interaction was obtained (e.g., failure memorizations sped backward movements relative to forward ones). The findings are novel yet consistent with theories of embodied cognition and self-regulation.

  11. The embodiment of success and failure as forward versus backward movements.

    Directory of Open Access Journals (Sweden)

    Michael D Robinson

    Full Text Available People often speak of success (e.g., "advance" and failure (e.g., "setback" as if they were forward versus backward movements through space. Two experiments sought to examine whether grounded associations of this type influence motor behavior. In Experiment 1, participants categorized success versus failure words by moving a joystick forward or backward. Failure categorizations were faster when moving backward, whereas success categorizations were faster when moving forward. Experiment 2 removed the requirement to categorize stimuli and used a word rehearsal task instead. Even without Experiment 1's response procedures, a similar cross-over interaction was obtained (e.g., failure memorizations sped backward movements relative to forward ones. The findings are novel yet consistent with theories of embodied cognition and self-regulation.

  12. Stratification of the Risk of Sudden Death in Nonischemic Heart Failure

    Directory of Open Access Journals (Sweden)

    Maurício Pimentel

    2014-10-01

    Full Text Available Despite significant therapeutic advancements, heart failure remains a highly prevalent clinical condition associated with significant morbidity and mortality. In 30%-40% patients, the etiology of heart failure is nonischemic. The implantable cardioverter-defibrillator (ICD is capable of preventing sudden death and decreasing total mortality in patients with nonischemic heart failure. However, a significant number of patients receiving ICD do not receive any kind of therapy during follow-up. Moreover, considering the situation in Brazil and several other countries, ICD cannot be implanted in all patients with nonischemic heart failure. Therefore, there is an urgent need to identify patients at an increased risk of sudden death because these would benefit more than patients at a lower risk, despite the presence of heart failure in both risk groups. In this study, the authors review the primary available methods for the stratification of the risk of sudden death in patients with nonischemic heart failure.

  13. Failure: A Source of Progress in Maintenance and Design

    Science.gov (United States)

    Chaïb, R.; Taleb, M.; Benidir, M.; Verzea, I.; Bellaouar, A.

    This approach, allows using the failure as a source of progress in maintenance and design to detect the most critical components in equipment, to determine the priority order maintenance actions to lead and direct the exploitation procedure towards the most penalizing links in this equipment, even define the necessary changes and recommendations for future improvement. Thus, appreciate the pathological behaviour of the material and increase its availability, even increase its lifespan and improve its future design. In this context and in the light of these points, the failures are important in managing the maintenance function. Indeed, it has become important to understand the phenomena of failure and degradation of equipments in order to establish an appropriate maintenance policy for the rational use of mechanical components and move to the practice of proactive maintenance [1], do maintenance at the design [2].

  14. NEESROCK: A Physical and Numerical Modeling Investigation of Seismically Induced Rock-Slope Failure

    Science.gov (United States)

    Applegate, K. N.; Wartman, J.; Keefer, D. K.; Maclaughlin, M.; Adams, S.; Arnold, L.; Gibson, M.; Smith, S.

    2013-12-01

    Worldwide, seismically induced rock-slope failures have been responsible for approximately 30% of the most significant landslide catastrophes of the past century. They are among the most common, dangerous, and still today, least understood of all seismic hazards. Seismically Induced Rock-Slope Failure: Mechanisms and Prediction (NEESROCK) is a major research initiative that fully integrates physical modeling (geotechnical centrifuge) and advanced numerical simulations (discrete element modeling) to investigate the fundamental mechanisms governing the stability of rock slopes during earthquakes. The research is part of the National Science Foundation-supported Network for Earthquake Engineering Simulation Research (NEES) program. With its focus on fractures and rock materials, the project represents a significant departure from the traditional use of the geotechnical centrifuge for studying soil, and pushes the boundaries of physical modeling in new directions. In addition to advancing the fundamental understanding of the rock-slope failure process under seismic conditions, the project is developing improved rock-slope failure assessment guidelines, analysis procedures, and predictive tools. Here, we provide an overview of the project, present experimental and numerical modeling results, discuss special considerations for the use of synthetic rock materials in physical modeling, and address the suitability of discrete element modeling for simulating the dynamic rock-slope failure process.

  15. Emerging therapies for the management of decompensated heart failure: from bench to bedside.

    Science.gov (United States)

    deGoma, Emil M; Vagelos, Randall H; Fowler, Michael B; Ashley, Euan A

    2006-12-19

    While pharmaceutical innovation has been highly successful in reducing mortality in chronic heart failure, this has not been matched by similar success in decompensated heart failure syndromes. Despite outstanding issues over definitions and end points, we argue in this paper that an unprecedented wealth of pharmacologic innovation may soon transform the management of these challenging patients. Agents that target contractility, such as cardiac myosin activators and novel adenosine triphosphate-dependent transmembrane sodium-potassium pump inhibitors, provide inotropic support without arrhythmogenic increases in cytosolic calcium or side effects of more traditional agents. Adenosine receptor blockade may improve glomerular filtration and diuresis by exerting a direct beneficial effect on glomerular blood flow while vasopressin antagonists promote free water excretion without compromising renal function and may simultaneously inhibit myocardial remodeling. Urodilatin, the renally synthesized isoform of atrial natriuretic peptide, may improve pulmonary congestion via vasodilation and enhanced diuresis. Finally, metabolic modulators such as perhexiline may optimize myocardial energy utilization by shifting adenosine triphosphate production from free fatty acids to glucose, a unique and conceptually appealing approach to the management of heart failure. These advances allow optimism not only for the advancement of our understanding and management of decompensated heart failure syndromes but for the translational research effort in heart failure biology in general.

  16. 46 CFR 308.516 - Failure to comply with Clause 21.

    Science.gov (United States)

    2010-10-01

    ....516 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.516 Failure to comply with Clause 21. (a) If the assured willfully fails to maintain a collateral deposit fund or a surety bond in...

  17. Technical analysis, contestation and politics in policy agenda setting and implementation : the rise and fall of primary care maternal services from Ghana’s capitation policy

    NARCIS (Netherlands)

    Koduah, A.; Dijk, van J.W.M.; Agyepong, I.A.

    2016-01-01

    Background: Why issues get on the policy agenda, move into policy formulation and implementation while others drop off in the process is an important field of enquiry to inform public social policy development and implementation. This paper seeks to advance our understanding of health policy agenda

  18. Comparison of usefulness of each of five predictors of mortality and urgent transplantation in patients with advanced heart failure.

    Science.gov (United States)

    Sachdeva, Amit; Horwich, Tamara B; Fonarow, Gregg C

    2010-09-15

    B-type natriuretic peptide (BNP), peak oxygen consumption (VO(2)), blood urea nitrogen (BUN), systolic blood pressure (SBP), and pulmonary capillary wedge pressure are all established predictors of mortality or urgent transplantation in patients with advanced heart failure (HF). However, their comparative predictive ability in estimating prognosis has not been well studied. We analyzed 1,215 patients with advanced systolic HF referred to a university center from 1999 to 2009. BUN, BNP, VO(2), SBP, and pulmonary capillary wedge pressure were measured as a part of the initial evaluation. The patients were divided into groups according to the best cutoffs for predicting both 1- and 2-year mortality from the analysis of the receiver operating characteristic curves (BNP > or =579 pg/ml, peak VO(2) or =53 mg/dl, SBP or =21 mm Hg). During a 2-year follow-up, 234 patients (19%) died, and 208 (17%) required urgent transplantation. BNP (odds ratio 4.3, 95% confidence interval 3.3 to 5.5) and peak VO(2) (odds ratio 4.5, 95% confidence interval 2.6 to 7.8) were the strongest predictors for death or urgent transplantation. On multivariate analyses, BNP and peak VO(2) were the strongest predictors for both death or urgent transplantation and all-cause mortality. The c-statistic was 0.756 for BNP, 0.701 for VO(2), 0.659 for BUN, 0.638 for SBP, and 0.650 for pulmonary capillary wedge pressure. In conclusion, of the 5 established predictors of outcomes in advanced HF, BNP was the most robust discriminator of risk and thus could be useful, along with other more traditional prognostic variables, in patient counseling regarding prognosis and determining the timing for heart transplantation. Copyright 2010 Elsevier Inc. All rights reserved.

  19. The nutrition policy process: the role of strategic capacity in advancing national nutrition agendas.

    Science.gov (United States)

    Pelletier, David L; Menon, Purnima; Ngo, Tien; Frongillo, Edward A; Frongillo, Dominic

    2011-06-01

    Undernutrition is the single largest contributor to the burden of disease in developing countries and has documented effects on social and economic development, yet progress in reducing undernutrition remains slow. This paper identifies the range of factors that have influenced the nutrition agenda in developing countries, in order to inform the implementation of three major global initiatives related to undernutrition. Data sources include interviews with nutrition practitioners at the national and international level, written accounts from six African countries, and observations of the policy process in five countries. Data were thematically coded to identify recurrent factors that facilitated or inhibited progress in addressing undernutrition. The data reveal the following: First, societal conditions and catalytic events pose a variety of challenges and opportunities to enlarge and shape the nutrition agenda. Some countries have been successful in using such opportunities, while others have been less successful and there have been some unintended consequences. Second, disagreements over interventions and strategies are an almost universal feature of the nutrition policy process, occur primarily among mid-level actors rather than among politicians or senior administrators, and are primarily the product of structural factors such as organizational mandates, interests, and differences in professional perspectives. Third, many of these structural factors can be molded, aligned, and/or circumvented through strategic action on the part of the mid-level actors to strengthen movement on the nutrition agenda. This evidence that strategic action can redirect and/or overcome the effects of structural factors has important implications for future efforts to advance the nutrition agenda.

  20. Recent advances in computational structural reliability analysis methods

    Science.gov (United States)

    Thacker, Ben H.; Wu, Y.-T.; Millwater, Harry R.; Torng, Tony Y.; Riha, David S.

    1993-10-01

    The goal of structural reliability analysis is to determine the probability that the structure will adequately perform its intended function when operating under the given environmental conditions. Thus, the notion of reliability admits the possibility of failure. Given the fact that many different modes of failure are usually possible, achievement of this goal is a formidable task, especially for large, complex structural systems. The traditional (deterministic) design methodology attempts to assure reliability by the application of safety factors and conservative assumptions. However, the safety factor approach lacks a quantitative basis in that the level of reliability is never known and usually results in overly conservative designs because of compounding conservatisms. Furthermore, problem parameters that control the reliability are not identified, nor their importance evaluated. A summary of recent advances in computational structural reliability assessment is presented. A significant level of activity in the research and development community was seen recently, much of which was directed towards the prediction of failure probabilities for single mode failures. The focus is to present some early results and demonstrations of advanced reliability methods applied to structural system problems. This includes structures that can fail as a result of multiple component failures (e.g., a redundant truss), or structural components that may fail due to multiple interacting failure modes (e.g., excessive deflection, resonate vibration, or creep rupture). From these results, some observations and recommendations are made with regard to future research needs.

  1. A recursive framework for time-dependent characteristics of tested and maintained standby units with arbitrary distributions for failures and repairs

    International Nuclear Information System (INIS)

    Vaurio, Jussi K.

    2015-01-01

    The time-dependent unavailability and the failure and repair intensities of periodically tested aging standby system components are solved with recursive equations under three categories of testing and repair policies. In these policies, tests or repairs or both can be minimal or perfect renewals. Arbitrary distributions are allowed to times to failure as well as to repair and renewal durations. Major preventive maintenance is done periodically or at random times, e.g. when a true demand occurs. In the third option process renewal is done if a true demand occurs or when a certain mission time has expired since the previous maintenance, whichever occurs first. A practical feature is that even if a repair can renew the unit, it does not generally renew the alternating process. The formalism updates and extends earlier results by using a special backward-renewal equation method, by allowing scheduled tests not limited to equal intervals and accepting arbitrary distributions and multiple failure types and causes, including failures caused by tests, human errors and true demands. Explicit solutions are produced to integral equations associated with an age-renewal maintenance policy. - Highlights: • Time-dependent unavailability, failure count and repair count for a standby system. • Free testing schedule and distributions for times to failure, repair and maintenance. • Multiple failure modes; tests or repairs or both can be minimal or perfect renewals. • Process renewals periodically, randomly or based on the process age or an initiator. • Backward renewal equations as explicit solutions to Volterra-type integral equations

  2. Chemical regulation on fire: rapid policy advances on flame retardants.

    Science.gov (United States)

    Cordner, Alissa; Mulcahy, Margaret; Brown, Phil

    2013-07-02

    Chemicals that are widely used in consumer products offer challenges to product manufacturers, risk managers, environmental regulators, environmental scientists, and the interested public. However, the factors that cause specific chemicals to rise to the level of regulatory, scientific, and social movement concern and scrutiny are not well documented, and scientists are frequently unclear about exactly how their research impacts policy. Through a case study of advocacy around flame retardant chemicals, this paper traces the pathways through which scientific evidence and concern is marshaled by both advocacy groups and media sources to affect policy change. We focus our analysis around a broad coalition of environmental and public health advocacy organizations and an investigative journalism series published in 2012 in the Chicago Tribune. We demonstrate that the Tribune series both brought the issue to a wider public audience and precipitated government action, including state policy revisions and federal Senate hearings. We also show how a broad and successful flame retardant coalition developed, leveraged a media event, and influenced policy at multiple institutional levels. The analysis draws on over 110 in-depth interviews, literature and Web site reviews, and observations at a flame retardant manufacturing company, government offices, and scientific and advocacy conferences.

  3. Advanced TCA BAckplane Tester

    CERN Document Server

    Oltean, Alexandra Dana; PGNet2005

    2005-01-01

    The “Advanced Telecom Computing Architecture” (AdvancedTCA) is a modular standard chassis based system designed to support the needs of carrier class telecommunication applications. It is defined by a set of industry standards under the direction of the PICMG group. One early deployment of the standard technology has been a 10 Gigabit Ethernet switch developed in the framework of the EU funded ESTA project. In order to study the practical aspects of high speed Ethernet switching at 10 Gigabit and above and to validate the signal integrity of the AdvancedTCA backplane, we developed a Backplane Tester. This system is able to run pseudo-random bit sequence (PRBS) traffic at 3.125 Gbps over every link on the AdvancedTCA backplane simultaneously, and to monitor any possible connectivity failure immediately in terms of the link and slot positions inside the chassis. In this paper, we describe the design and the practical architectural hardware and software aspects of the AdvancedTCA Backplane Tester. We also pr...

  4. Intraoperative Radiotherapy (IORT) for Locally Advanced Colorectal Cancer

    International Nuclear Information System (INIS)

    Kim, Myung Se; Kim, Sung Kyu; Kim, Jae Hwang; Kwan, Koing Bo; Kim, Heung Dae

    1991-01-01

    Colorectal cancer is the second most frequent malignant tumor in the United States and fourth most frequent tumor in Korea. Surgery has been used as a primary treatment modality but reported overall survivals after curative resection were from 20% to 50%. Local recurrence is the most common failure in the treatment of locally advanced colorectal cancer. Once recurrence has developed, surgery has rarely the role and the five year survival of locally advanced rectal cancer is less than 5%, this indicated that significant improvement of local control could be achieved. We performed 6 cases of IORT for locally advanced colorectal cancer which is he first experience in Korea. Patient's eligibility, treatment applicator, electron energy, dose distribution on the surface and depth within the treatment field and detailed skills are discussed. We hope that our IORT protocol can reduce local failure and increase the long term survival significantly

  5. Invasive hemodynamic characterization of heart failure with preserved ejection fraction

    DEFF Research Database (Denmark)

    Andersen, Mads Jønsson; Borlaug, Barry A

    2014-01-01

    Recent hemodynamic studies have advanced our understanding of heart failure with preserved ejection fraction (HFpEF). Despite improved pathophysiologic insight, clinical trials have failed to identify an effective treatment for HFpEF. Invasive hemodynamic assessment can diagnose or exclude HFp...

  6. 12 CFR 725.22 - Advances to insurance organizations.

    Science.gov (United States)

    2010-01-01

    ... NATIONAL CREDIT UNION ADMINISTRATION CENTRAL LIQUIDITY FACILITY § 725.22 Advances to insurance organizations. (a) In accordance with policies established by the NCUA Board, the Facility may advance funds to... not be renewable at maturity, and (4) The funds advanced shall not be relent at an interest rate...

  7. Strategies to improve self-management in heart failure patients.

    Science.gov (United States)

    Toback, Mehnosh; Clark, Nancy

    2017-02-01

    Heart failure is one of the most common causes of hospitalization, hospital readmission and death. Patients with heart failure have many complications, with multiple co-existing diagnoses which result in polypharmacy. Following instructions provided by many physicians, medication adjustments based on changes in their symptoms are required. Behavioral adjustments concerning diet and exercise regime are recommended. Therefore, the patient plays a crucial role in the management of heart failure. To review the available studies on heart failure self-management, and investigate educational, behavioral and psychosocial strategies that plays an important role to improve patient self-management. A literature review was conducted based upon the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidance. The articles identified through an extensive search using PubMed and UpToDate from 1999 to 2016. Improved self-management will increase compliance, promote patient quality-of-life, advance clinical outcomes, reduce hospital re-admission and will decrease hospitalization costs.

  8. Further Democratizing Latin America: Broadening Access to Higher Education and Promoting Science Policies Focused on the Advanced Training of Human Resources

    Directory of Open Access Journals (Sweden)

    Manuel Heitor

    2014-08-01

    Full Text Available We focus this paper on the conditions to build reliable science, technology and higher education systems in Latin America, based on international comparative studies, fieldwork and interviews conducted over the last three years. The analysis shows that science can have a major role in furthering the democratization of society through public policies that foster opportunities to access knowledge and the advanced training of human resources. Broadening the social basis for higher education promotes the qualification of the labour force and contributes to social and economic development. The need to guarantee higher education diversity, strengthening scientific institutions and investing in a strong science base, is deemed as critical, but goes far beyond policies centred on innovation and industry-science relationships. It requires adequate training and attraction of skilled people, as well as the social promotion of a scientific and technological culture.

  9. Uncertain climate policy and the green paradox

    NARCIS (Netherlands)

    Smulders, Sjak A.; Tsur, Y.; Zemel, A.; Moser, E.; Semmler, W.; Tragler, G.; Veliov, V.

    2014-01-01

    Unintended consequences of announcing a climate policy well in advance of its implementation have been studied in a variety of situations. We show that a phenomenon akin to the so-called “Green-Paradox” holds also when the policy implementation date is uncertain. Governments are compelled, by

  10. One goal, several means? - Combinations of policy instruments in climate policy; Ett maal flera medel? - Styrmedelskombinationer i klimatpolitiken

    Energy Technology Data Exchange (ETDEWEB)

    Soederholm, Patrik

    2012-04-15

    The purpose of this report is, based on previous theoretical and empirical research, to analyze the conditions under which a combination of policy instruments can improve the effectiveness of climate policy and which the most important general lessons are, for the design of various policy instruments and combinations thereof. The focus of the report is based primarily on the achievement of long-term climate goals, especially an adaptation to radically lower emissions levels by 2050. This entails that we pay special attention to how policies can be designed to promote technological development on climate change, and how the relationship between an effective, legitimate and politically viable climate policy can be designed (including the need for so-called second-best solutions). The analysis assumes that the instruments are introduced to promote economic efficiency. An economically efficient climate policy means: A policy that ensures that a given reduction in emissions of greenhouse gases can be done at the lowest possible economic cost (known as cost-effectiveness) and that the reduction is driven to the point where the cost of further reduction is as high as the value of the marginal damage. A central task of an effective policy is to identify situations which means that economically efficient measures will not be implemented spontaneously by the market players. In a market economy the outcomes is determined of the millions of decisions by individual actors (households and companies) do in everyday life, and the central question is therefore whether these actors face incentives to ensure efficient choices. If not, it may be the result of a so-called market failure and the role of politics will be to correct for this failure. The analysis is based on a number of important limitations. The report consists of a literature synthesis. We don't make any assessment of the empirical importance of different motifs that may be the basis for the introduction of

  11. A bivariate optimal replacement policy for a multistate repairable system

    International Nuclear Information System (INIS)

    Zhang Yuanlin; Yam, Richard C.M.; Zuo, Ming J.

    2007-01-01

    In this paper, a deteriorating simple repairable system with k+1 states, including k failure states and one working state, is studied. It is assumed that the system after repair is not 'as good as new' and the deterioration of the system is stochastic. We consider a bivariate replacement policy, denoted by (T,N), in which the system is replaced when its working age has reached T or the number of failures it has experienced has reached N, whichever occurs first. The objective is to determine the optimal replacement policy (T,N)* such that the long-run expected profit per unit time is maximized. The explicit expression of the long-run expected profit per unit time is derived and the corresponding optimal replacement policy can be determined analytically or numerically. We prove that the optimal policy (T,N)* is better than the optimal policy N* for a multistate simple repairable system. We also show that a general monotone process model for a multistate simple repairable system is equivalent to a geometric process model for a two-state simple repairable system in the sense that they have the same structure for the long-run expected profit (or cost) per unit time and the same optimal policy. Finally, a numerical example is given to illustrate the theoretical results

  12. A Study of Failure Events in Drinking Water Systems As a Basis for Comparison and Evaluation of the Efficacy of Potable Reuse Schemes.

    Science.gov (United States)

    Onyango, Laura A; Quinn, Chloe; Tng, Keng H; Wood, James G; Leslie, Greg

    2015-01-01

    Potable reuse is implemented in several countries around the world to augment strained water supplies. This article presents a public health perspective on potable reuse by comparing the critical infrastructure and institutional capacity characteristics of two well-established potable reuse schemes with conventional drinking water schemes in developed nations that have experienced waterborne outbreaks. Analysis of failure events in conventional water systems between 2003 and 2013 showed that despite advances in water treatment technologies, drinking water outbreaks caused by microbial contamination were still frequent in developed countries and can be attributed to failures in infrastructure or institutional practices. Numerous institutional failures linked to ineffective treatment protocols, poor operational practices, and negligence were detected. In contrast, potable reuse schemes that use multiple barriers, online instrumentation, and operational measures were found to address the events that have resulted in waterborne outbreaks in conventional systems in the past decade. Syndromic surveillance has emerged as a tool in outbreak detection and was useful in detecting some outbreaks; increases in emergency department visits and GP consultations being the most common data source, suggesting potential for an increasing role in public health surveillance of waterborne outbreaks. These results highlight desirable characteristics of potable reuse schemes from a public health perspective with potential for guiding policy on surveillance activities.

  13. Analysis of the Policies for Female Teachers in Korea.

    Science.gov (United States)

    Min, Moo Sook

    2000-01-01

    Reviews Korean female-teacher-related policies, focusing on: policies for improving the working conditions of women in schools; promotion-related policies for facilitating female teachers' advancement to administrative posts; and a gender-quota system for reducing the proportion of female teachers in the teaching profession. The paper concludes…

  14. Impact of primary para-aortic lymphadenectomy on distant failure in locally advanced cervical cancer patients treated in the era of image-guided adaptive brachytherapy.

    Science.gov (United States)

    Chargari, Cyrus; Mazeron, Renaud; Dunant, Ariane; Gouy, Sébastien; Petit, Claire; Maroun, Pierre; Uzan, Catherine; Annede, Pierre; Bentivegna, Enrica; Balleyguier, Corinne; Genestie, Catherine; Pautier, Patricia; Leary, Alexandra; Lhomme, Catherine; Deutsch, Eric; Morice, Philippe; Haie-Meder, Christine

    2016-12-01

    To investigate the impact of a primary para-aortic lymphadenectomy (PAL) in locally advanced cervical cancer patients receiving definitive chemoradiation, we reviewed the clinical records of consecutive patients treated in our Institution and receiving an external beam irradiation followed with an image-guided adaptive brachytherapy for a locally advanced cervical cancer. We examined the impact of performing a primary PAL as part of primary staging for guiding irradiation fields in patients without extra-pelvic PET uptake. The outcome of patients presenting para-aortic lymph node uptake (PALNU) was also examined. 186 patients were identified. Median follow-up was 44.4 months. Patients receiving a primary PAL (PAL group) and those who received upfront pelvic chemoradiation (no-PAL group) did not significantly differ for loco-regional failures. Survival without distant failure (DFFS), including para-aortic relapses, was at 3 years 87 % (95 % CI 84-90 %) in PAL group, 67 % (95 % CI 59-85 %) in the no-PAL group and 44 % (95 % CI 32-66 %) in the PALNU group (p = 0.04 for comparison between PAL and no-PAL groups). In a multivariate model including para-aortic lymphadenectomy, pelvic nodal uptake and high-risk clinical target volume as adjustment variables, a para-aortic lymphadenectomy was significant for DFS (HR = 0.47, 95 % CI 0.26-0.84, p = 0.01). Although confounding factors could account for these retrospective results, a primary PAL with tailored irradiation fields based on para-aortic histological findings seems to be associated with a better control for distant metastases. A randomized trial is testing the benefit of this strategy.

  15. Development and application of a probabilistic evaluation method for advanced process technologies. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Frey, H.C.; Rubin, E.S.

    1991-04-01

    The objective of this work is to develop and apply a method for research planning for advanced process technologies. To satisfy requirements for research planning, it is necessary to: (1) identify robust solutions to process design questions in the face of uncertainty to eliminate inferior design options; (2) identify key problem areas in a technology that should be the focus of further research to reduce the risk of technology failure; (3) compare competing technologies on a consistent basis to determine the risks associated with adopting a new technology; and (4) evaluate the effects that additional research might have on comparisons with conventional technology. An important class of process technologies are electric power plants. In particular, advanced clean coal technologies are expected to play a key role in the energy and environmental future of the US, as well as in other countries. Research planning for advanced clean coal technology development is an important part of energy and environmental policy. Thus, the research planning method developed here is applied to case studies focusing on a specific clean coal technology. The purpose of the case studies is both to demonstrate the research planning method and to obtain technology-specific conclusions regarding research strategies.

  16. Policy resistance undermines superspreader vaccination strategies for influenza.

    Directory of Open Access Journals (Sweden)

    Chad R Wells

    Full Text Available Theoretical models of infection spread on networks predict that targeting vaccination at individuals with a very large number of contacts (superspreaders can reduce infection incidence by a significant margin. These models generally assume that superspreaders will always agree to be vaccinated. Hence, they cannot capture unintended consequences such as policy resistance, where the behavioral response induced by a new vaccine policy tends to reduce the expected benefits of the policy. Here, we couple a model of influenza transmission on an empirically-based contact network with a psychologically structured model of influenza vaccinating behavior, where individual vaccinating decisions depend on social learning and past experiences of perceived infections, vaccine complications and vaccine failures. We find that policy resistance almost completely undermines the effectiveness of superspreader strategies: the most commonly explored approaches that target a randomly chosen neighbor of an individual, or that preferentially choose neighbors with many contacts, provide at best a 2% relative improvement over their non-targeted counterpart as compared to 12% when behavioral feedbacks are ignored. Increased vaccine coverage in super spreaders is offset by decreased coverage in non-superspreaders, and superspreaders also have a higher rate of perceived vaccine failures on account of being infected more often. Including incentives for vaccination provides modest improvements in outcomes. We conclude that the design of influenza vaccine strategies involving widespread incentive use and/or targeting of superspreaders should account for policy resistance, and mitigate it whenever possible.

  17. Energy sector methane recovery and use: the importance of policy

    Energy Technology Data Exchange (ETDEWEB)

    Tom Kerr; Michelle Hershman

    2009-08-15

    To raise awareness about appropriate policy options to advance methane recovery and use in the energy sector, the IEA has conducted a series of analyses and studies over the past few years. This report continues IEA efforts by providing policy makers with examples and best practices in methane mitigation policy design and implementation. This report offers an overview of four types of methane mitigation projects that have the strongest links to the energy sector: oil and gas methane recovery and reduction of leaks and losses; coal mine methane; landfill methane; and manure methane recovery and use. It identifies successful policies that have been used to advance these important projects. This information is intended to guide policy makers as they search for low-cost, near-term solutions to climate change. 38 refs., 10 figs., 1 app.

  18. 2013 update on congenital heart disease, clinical cardiology, heart failure, and heart transplant.

    Science.gov (United States)

    Subirana, M Teresa; Barón-Esquivias, Gonzalo; Manito, Nicolás; Oliver, José M; Ripoll, Tomás; Lambert, Jose Luis; Zunzunegui, José L; Bover, Ramon; García-Pinilla, José Manuel

    2014-03-01

    This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  19. Recent advances on failure and recovery in networks of networks

    International Nuclear Information System (INIS)

    Shekhtman, Louis M.; Danziger, Michael M.; Havlin, Shlomo

    2016-01-01

    Until recently, network science has focused on the properties of single isolated networks that do not interact or depend on other networks. However it has now been recognized that many real-networks, such as power grids, transportation systems, and communication infrastructures interact and depend on other networks. Here, we will present a review of the framework developed in recent years for studying the vulnerability and recovery of networks composed of interdependent networks. In interdependent networks, when nodes in one network fail, they cause dependent nodes in other networks to also fail. This is also the case when some nodes, like for example certain people, play a role in two networks, i.e. in a multiplex. Dependency relations may act recursively and can lead to cascades of failures concluding in sudden fragmentation of the system. We review the analytical solutions for the critical threshold and the giant component of a network of n interdependent networks. The general theory and behavior of interdependent networks has many novel features that are not present in classical network theory. Interdependent networks embedded in space are significantly more vulnerable compared to non-embedded networks. In particular, small localized attacks may lead to cascading failures and catastrophic consequences. Finally, when recovery of components is possible, global spontaneous recovery of the networks and hysteresis phenomena occur. The theory developed for this process points to an optimal repairing strategy for a network of networks. Understanding realistic effects present in networks of networks is required in order to move towards determining system vulnerability.

  20. A trivariate optimal replacement policy for a deteriorating system based on cumulative damage and inspections

    International Nuclear Information System (INIS)

    Tsai, Hsin-Nan; Sheu, Shey-Huei; Zhang, Zhe George

    2017-01-01

    In this article, we study a trivariate replacement model for a deteriorating system consisting of two units. Failures of unit 1 can be classified into two types. Type I failure (minor failure) is fixed by a minimal repair and type II failure (catastrophic failure) is removed by a replacement. Both types of failures can only be detected through inspection. Each type I failure of unit 1 will result in a random amount of damage to unit 2 and the damages are cumulative. The probability of type I failure or type II failure is assumed to depend on the number of failures since the last replacement. We formulate a replacement policy based on the number of type I failure, the occurrence of the first type II failure, and the amount of accumulative damages. Hence the system is replaced either preventively or correctively at any of the following four conditions depend on whichever occurs first; preventively (a) at the Nth type I failure; or (b) when the total damage of unit 2 exceeds a pre-specified level Z (but less than the failure level l); and, correctively (c) at the first type II failure; or (d) when the total damage of unit 2 exceeds a failure level l, where Z and l represent the thresholds of total damage level for unit 2 to preventive and corrective replacements, respectively. Although a type I failure can be fixed by a minimal repair, but the operating period is stochastically decreasing and repair time is stochastically increasing as time goes on. The minimal total expected long-run net cost per unit time of the system is derived and a computational algorithm for determining the optimal policy is developed. A real-world application from electric power industry is provided. Several past studied are shown to be special cases of our model. Finally, a numerical example is presented. - Highlights: • A trivariate replacement policy for a deteriorating system with two units is proposed. • A real-world application from the electric power industry is provided. • The

  1. Airline Deregulation and Public Policy

    Science.gov (United States)

    Morrison, Steven A.; Winston, Clifford

    1989-08-01

    An assessment of the effects of airline deregulation on travelers and carriers indicates that deregulation has provided travelers and carriers with 14.9 billion of annual benefits (1988 dollars). Airport congestion, airline safety, airline bankruptcy, and mergers are also analyzed and found in most cases to have reduced benefits. But, these costs should not be attributed to deregulation per se, but to failures by the government to pursue appropriate policies in these areas. Pursuit of policies that promote airline competition and efficient use of airport capacity would significantly increase the benefits from deregulation and would provide valuable guidance for other industries undergoing the transition to deregulation.

  2. Decreasing the commutation failure frequency in HVDC transmission systems

    DEFF Research Database (Denmark)

    Hansen (retired June, 2000), Arne; Havemann (retired June, 2000), Henrik

    2000-01-01

    In this paper we show how a fairly large proportion of those commutation failures that are due to single-phased short circuits to earth can be avoided. In a control circuit based on a digital signal processor (DSP) it is possible, with instantaneous results, to switch from a normal control strategy...... with equidistant firing pulses to a strategy that takes into consideration the potentially dangerous voltage changes on the supply lines, If the supply voltages are monitored continuously, it is possible to calculate the necessity of advancing the firing pulses to avoid commutation failures. In the paper...

  3. An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers.

    Science.gov (United States)

    Doorenbos, Ardith Z; Levy, Wayne C; Curtis, J Randall; Dougherty, Cynthia M

    2016-09-01

    Heart failure patients contend with a markedly impaired quality of life, experiencing emotional distress and severe physical discomfort that increases in frequency in the last months of life. Improving communication between patients and providers about goals of care has the potential to improve patient-provider communication and patient outcomes. To determine the effects of a goals-of-care (GoC) intervention compared to usual care on the number of GoC conversations, quality of communication between patients and providers, referrals to palliative care services and completion of advance care directives. A two-group randomized study (n = 40/group) compared a GoC intervention to usual care, conducted in an academic heart failure (HF) clinic. The GoC intervention was a previsit patient activation-education, telephone-based intervention delivered by a nurse. The primary outcome of the study was number of GoC conversations between HF patients and HF providers. Secondary outcomes were quality of communication, number of referrals to palliative care, and completion of advance directives. Patients averaged 58.15 ± 11.26 years of age, with mean left ventricular ejection fraction = 30.31 ± 9.72% and Seattle Heart Failure Model scores = 95.1 ± 1.60. There was a significant increase in goals-of-care conversations (58% vs. 2.6%, P communication (P = 0.03) in the GoC group compared to usual care after the intervention. There were no differences between groups on the other outcomes. The GoC intervention resulted in more GoC conversations and higher quality communication between HF patients and providers without increased anxiety or depression. Further studies are needed to assess impact on longer term quality of care and patient outcomes. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. The Evolution of Failure Analysis at NASA's Kennedy Space Center and the Lessons Learned

    Science.gov (United States)

    Long, Victoria S.; Wright, M. Clara; McDanels, Steve

    2015-01-01

    The United States has had four manned launch programs and three station programs since the era of human space flight began in 1961. The launch programs, Mercury, Gemini, Apollo, and Shuttle, and the station programs, Skylab, Shuttle-Mir, and the International Space Station (ISS), have all been enormously successful, not only in advancing the exploration of space, but also in advancing related technologies. As each subsequent program built upon the successes of previous programs, they similarly learned from their predecessors' failures. While some failures were spectacular and captivated the attention of the world, most only held the attention of the dedicated men and women working to make the missions succeed.

  5. Toward full-chip prediction of yield-limiting contact patterning failure: correlation of simulated image parameters to advanced contact metrology metrics

    Science.gov (United States)

    Sturtevant, John L.; Chou, Dyiann

    2006-03-01

    Electrical failure due to incomplete contacts or vias has arisen as one of the primary modes of yield loss for 130 nm and below designs in manufacturing. Such failures are generally understood to arise from both random and systematic sources. The addition of redundant vias, where possible, has long been an accepted DFM practice for mitigating the impact of random defects. Incomplete vias are often characterized by having a diameter near the target dimension but a depth of less than 100% of target. As such, it is a difficult problem to diagnose and debug in-line, since bright and dark field optical inspection systems cannot typically distinguish between a closed, partially open and fully open contact. Advanced metrology systems have emerged in recent years to meet this challenge, but no perfect manufacturing solution has yet been identified for full field verification of all contacts. Voltage Contrast (VC) SEM metrology biases the wafer to directly measure electrical conductivity after fill / polish, and can therefore easily discern a lack of electrical connection to the underlying conductor caused by incomplete photo, etch, or fill processing. While an entire wafer can in principal be VC scanned, throughput limitations dictate very sparse sampling in manufacturing. SEM profile grading (PG) leverages the rich content of the secondary electron waveform to decipher information about the bottom of the contact. Several authors have demonstrated an excellent response of the Profile Grade to intentional defocus vectors. However, the SEM can only target discreet or single digit groupings of contacts, and therefore requires intelligent guidance to identify those contacts which are most prone to failure, enabling protection of the fab WIP. An a-priori knowledge of which specific contacts in a layout are most likely to fail would prove very useful for proactive inspection in manufacturing. Model based pre-manufacturing verification allows for such knowledge to be communicated

  6. Technical analysis, contestation and politics in policy agenda setting and implementation

    NARCIS (Netherlands)

    Koduah, Augustina; Dijk, van Han; Agyepong, Irene Akua

    2016-01-01

    Background: Why issues get on the policy agenda, move into policy formulation and implementation while others drop off in the process is an important field of enquiry to inform public social policy development and implementation. This paper seeks to advance our understanding of health policy

  7. The Rising Tiger (United States Policy Consideration towards Southeast Asia)

    National Research Council Canada - National Science Library

    Douglas, Carla; Pagliano, Gary; Rosner, Elliot J

    1997-01-01

    .... soldiers Island-hopped through the Philippines enjoying ultimate victory in the Pacific theater, while during the Vietnam War, the United States experienced policy failures and conflicts in the nation's will...

  8. Financial Crises As the Failure of Arbitrage: Implications for Monetary Policy

    OpenAIRE

    Saito, Makoto; Shiratsuka, Shigenori

    2001-01-01

    This paper attempts to view financial crises as the failure of arbitrage among financial markets, and takes the “Japan premium” phenomenon observed in offshore money markets as an important example in favor of this view. In addition, we reconsider, from this perspective, the open market operations conducted by a central bank during a period of financial distress. The paper first derives from the existing theoretical literature several implications regarding how arbitrage among markets is prev...

  9. Failure analysis of carbide fuels under transient overpower (TOP) conditions

    International Nuclear Information System (INIS)

    Nguyen, D.H.

    1980-06-01

    The failure of carbide fuels in the Fast Test Reactor (FTR) under Transient Overpower (TOP) conditions has been examined. The Beginning-of-Cycle Four (BOC-4) all-oxide base case, at $.50/sec ramp rate was selected as the reference case. A coupling between the advanced fuel performance code UNCLE-T and HCDA Code MELT-IIIA was necessary for the analysis. UNCLE-T was used to determine cladding failure and fuel preconditioning which served as initial conditions for MELT-III calculations. MELT-IIIA determined the time of molten fuel ejection from fuel pin

  10. Optimization of rock-bit life based on bearing failure criteria

    International Nuclear Information System (INIS)

    Feav, M.J.; Thorogood, J.L.; Whelehan, O.P.; Williamson, H.S.

    1992-01-01

    This paper reports that recent advances in rock-bit seal technology have allowed greater predictability of bearing life. Cone loss following bearing failure incurs costs related to remedial activities. A risk analysis approach, incorporating bearing-life relationships and the inter-dependence of drilling events, is used to formulate a bit-run cost-optimization method. The procedure enables a choice to be made between elastomeric and metal seals on a lowest-replacement-cost basis. The technique also provides a formal method for assessing the opportunity cost for using a device to detect bit-bearing failures downhole

  11. Data Policy

    Directory of Open Access Journals (Sweden)

    Mark A Parsons

    2013-07-01

    Full Text Available The first purpose of data policy should be to serve the objectives of the organization or project sponsoring the collection of the data. With research data, data policy should also serve the broader goals of advancing scientific and scholarly inquiry and society at large. This is especially true with government-funded data, which likely comprise the vast majority of research data. Data policy should address multiple issues, depending on the nature and objectives of the data. These issues include data access requirements, data preservation and stewardship requirements, standards and compliance mechanisms, data security issues, privacy and ethical concerns, and potentially even specific collection protocols and defined data flows. The specifics of different policies can vary dramatically, but all data policies need to address data access and preservation. Research data gain value with use and must therefore be accessible and preserved for future access. This article focuses on data access. While policy might address multiple issues, at a first level it must address where the data stand on what Lyon (2009 calls the continuum of openness. Making data as openly accessible as possible provides the greatest societal benefit, and a central purpose of data policy is to work toward ethically open data access. An open data regime not only maximizes the benefit of the data, it also simplifies most of the other issues around effective research data stewardship and infrastructure development.

  12. Software verification and validation methodology for advanced digital reactor protection system using diverse dual processors to prevent common mode failure

    International Nuclear Information System (INIS)

    Son, Ki Chang; Shin, Hyun Kook; Lee, Nam Hoon; Baek, Seung Min; Kim, Hang Bae

    2001-01-01

    The Advanced Digital Reactor Protection System (ADRPS) with diverse dual processors is being developed by the National Research Lab of KOPEC for ADRPS development. One of the ADRPS goals is to develop digital Plant Protection System (PPS) free of Common Mode Failure (CMF). To prevent CMF, the principle of diversity is applied to both hardware design and software design. For the hardware diversity, two different types of CPUs are used for Bistable Processor and Local Coincidence Logic Processor. The VME based Single Board Computers (SBC) are used for the CPU hardware platforms. The QNX Operating System (OS) and the VxWorks OS are used for software diversity. Rigorous Software Verification and Validation (V and V) is also required to prevent CMF. In this paper, software V and V methodology for the ADRPS is described to enhance the ADRPS software reliability and to assure high quality of the ADRPS software

  13. Greening the Danes? Experience with consumption and environment policies

    DEFF Research Database (Denmark)

    Christensen, Toke Haunstrup; Godskesen, Mirjam Irene; Gram-Hanssen, Kirsten

    2007-01-01

    structures, and information are all in accordance with each other, and this is only the case when sustainable consumption does not conflict with economic growth. A more fundamental critique thus concerns the failure of Danish consumer-oriented environmental policies to address consumption growth......Consumer-oriented environmental policies came high on the political agenda during the 1990s. Internationally, consumers were assigned a key role in environmental policies; also in Denmark, political initiatives were taken to promote sustainable consumer behaviour. In this article, the results...... of Danish policies related to consumption and environment are assessed by considering first, the environmental impacts of the political measures, and second, whether the policies have succeeded in addressing the dynamics behind increasing consumption. The study combines a theoretical understanding...

  14. Advanced composites structural concepts and materials technologies for primary aircraft structures: Structural response and failure analysis

    Science.gov (United States)

    Dorris, William J.; Hairr, John W.; Huang, Jui-Tien; Ingram, J. Edward; Shah, Bharat M.

    1992-01-01

    Non-linear analysis methods were adapted and incorporated in a finite element based DIAL code. These methods are necessary to evaluate the global response of a stiffened structure under combined in-plane and out-of-plane loading. These methods include the Arc Length method and target point analysis procedure. A new interface material model was implemented that can model elastic-plastic behavior of the bond adhesive. Direct application of this method is in skin/stiffener interface failure assessment. Addition of the AML (angle minus longitudinal or load) failure procedure and Hasin's failure criteria provides added capability in the failure predictions. Interactive Stiffened Panel Analysis modules were developed as interactive pre-and post-processors. Each module provides the means of performing self-initiated finite elements based analysis of primary structures such as a flat or curved stiffened panel; a corrugated flat sandwich panel; and a curved geodesic fuselage panel. This module brings finite element analysis into the design of composite structures without the requirement for the user to know much about the techniques and procedures needed to actually perform a finite element analysis from scratch. An interactive finite element code was developed to predict bolted joint strength considering material and geometrical non-linearity. The developed method conducts an ultimate strength failure analysis using a set of material degradation models.

  15. Stability and performance of propulsion control systems with distributed control architectures and failures

    Science.gov (United States)

    Belapurkar, Rohit K.

    Future aircraft engine control systems will be based on a distributed architecture, in which, the sensors and actuators will be connected to the Full Authority Digital Engine Control (FADEC) through an engine area network. Distributed engine control architecture will allow the implementation of advanced, active control techniques along with achieving weight reduction, improvement in performance and lower life cycle cost. The performance of a distributed engine control system is predominantly dependent on the performance of the communication network. Due to the serial data transmission policy, network-induced time delays and sampling jitter are introduced between the sensor/actuator nodes and the distributed FADEC. Communication network faults and transient node failures may result in data dropouts, which may not only degrade the control system performance but may even destabilize the engine control system. Three different architectures for a turbine engine control system based on a distributed framework are presented. A partially distributed control system for a turbo-shaft engine is designed based on ARINC 825 communication protocol. Stability conditions and control design methodology are developed for the proposed partially distributed turbo-shaft engine control system to guarantee the desired performance under the presence of network-induced time delay and random data loss due to transient sensor/actuator failures. A fault tolerant control design methodology is proposed to benefit from the availability of an additional system bandwidth and from the broadcast feature of the data network. It is shown that a reconfigurable fault tolerant control design can help to reduce the performance degradation in presence of node failures. A T-700 turbo-shaft engine model is used to validate the proposed control methodology based on both single input and multiple-input multiple-output control design techniques.

  16. Policy-Making Theory as an Analytical Framework in Policy Analysis: Implications for Research Design and Professional Advocacy.

    Science.gov (United States)

    Sheldon, Michael R

    2016-01-01

    Policy studies are a recent addition to the American Physical Therapy Association's Research Agenda and are critical to our understanding of various federal, state, local, and organizational policies on the provision of physical therapist services across the continuum of care. Policy analyses that help to advance the profession's various policy agendas will require relevant theoretical frameworks to be credible. The purpose of this perspective article is to: (1) demonstrate the use of a policy-making theory as an analytical framework in a policy analysis and (2) discuss how sound policy analysis can assist physical therapists in becoming more effective change agents, policy advocates, and partners with other relevant stakeholder groups. An exploratory study of state agency policy responses to address work-related musculoskeletal disorders is provided as a contemporary example to illustrate key points and to demonstrate the importance of selecting a relevant analytical framework based on the context of the policy issue under investigation. © 2016 American Physical Therapy Association.

  17. Advancing the field of elder abuse: future directions and policy implications.

    Science.gov (United States)

    Dong, XinQi

    2012-11-01

    Elder abuse, sometimes called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse; neglect (caregiver neglect and self-neglect); and financial exploitation. Evidence suggests that one in 10 older adults experiences some form of elder abuse, but only one in 25 cases is reported to social services agencies. At the same time, elder abuse is associated with significant morbidity and premature mortality. Despite these findings, there is a great paucity in research, practice, and policy addressing the pervasive issues of elder abuse. Through my experiences as a American Political Sciences Association Congressional Policy Fellow and Health and Aging Policy Fellow working with the Administration on Community Living (ACL) (previously known as the Administration on Aging) for the last 2 years, I will describe the major functions of the ACL and highlight two major pieces of federal legislation: The Older Americans Act and the Elder Justice Act. I will also highlight major research gaps and future policy relevant research directions for the field of elder abuse. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  18. Conflict within the Turkish foreign policy decision making mechanism:

    OpenAIRE

    Oğuz, Mustafa; Oguz, Mustafa

    2005-01-01

    This thesis presents an analysis of Turkish foreign policy decision making in a theoretical model and argues that Turkish foreign policy is a product of negotiation and compromises among various foreign policy making actors. Theoretical foundation is built on decision units framework advanced by Margaret G. Herman. It applies this framework to two cases and four decision occasions to investigate who made foreign policy decisions and how this influenced foreign policy of Turkey. The first case...

  19. Heart failure services in the United Kingdom: rethinking the machine bureaucracy.

    Science.gov (United States)

    Hawkins, Nathaniel M; Wright, David J; Capewell, Simon

    2013-01-20

    Poor outcomes and poor uptake of evidence based therapies persist for patients with heart failure in the United Kingdom. We offer a strategic analysis of services, defining the context, organization and objectives of the service, before focusing on implementation and performance. Critical flaws in past service development and performance are apparent, a consequence of failed performance management, policy and political initiative. The barriers to change and potential solutions are common to many health care systems. Integration, information, financing, incentives, innovation and values: all must be challenged and improved if heart failure services are to succeed. Modern healthcare requires open adaptive systems, continually learning and improving. The system also needs controls. Performance indicators should be simple, clinically relevant, and outcome focused. Heart failure presents one of the greatest opportunities to improve symptoms and survival with existing technology. To do so, heart failure services require radical reorganization. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  20. Macro-Prudential Policies to Mitigate Financial System Vulnerabilities

    NARCIS (Netherlands)

    Claessens, S.; Ghosh, S.R.; Mihet, R.

    2014-01-01

    Macro-prudential policies aimed at mitigating systemic financial risks have become part of the policy toolkit in many emerging markets and some advanced countries. Their effectiveness and efficacy are not well-known, however. Using panel data regressions, we analyze how changes in balance sheets of

  1. Coordination of innovation, energy and environmental policy

    International Nuclear Information System (INIS)

    Rave, Tilmann; Triebswetter, Ursula; Wackerbauer, Johann

    2013-01-01

    The present study is dedicated to an investigation of the interplay of innovation, energy and environmental policy and the policy instruments used in each of these fields. A substantial amount of coordination is required in order to bring about the envisaged transformation of Germany's energy supply system and the political goals associated with this, especially given the altered political environment and framework conditions. Failure to act on this need could lead to political goals being missed or frustrated, unnecessary costs or other undesirable side-effects such as unfavourable distribution effects. [de

  2. Optimising Age-Replacement and Extended Non-Renewing Warranty Policies in Lifecycle Costing

    OpenAIRE

    Wu, Shaomin; Longhurst, Phil

    2011-01-01

    This paper analyses the life cycle cost of equipment protected by both base and extended warranty policies from a consumer's perspective. We assume that the equipment has two types of failure: minor and catastrophic. A minor failure can be corrected with minimal repair whereas a catastrophic failure can only be removed by a replacement. It is assumed that equipment is maintained at no charge to the consumer during the warranty period, whereas the consumer is fully charged for any maintenance ...

  3. Effects of intravenous home dobutamine in palliative end-stage heart failure on quality of life, heart failure hospitalization, and cost expenditure.

    Science.gov (United States)

    Martens, Pieter; Vercammen, Jan; Ceyssens, Wendy; Jacobs, Linda; Luwel, Evert; Van Aerde, Herwig; Potargent, Peter; Renaers, Monique; Dupont, Matthias; Mullens, Wilfried

    2018-01-17

    In patients with palliative end-stage heart failure, interventions that could provide symptomatic relief and prevent hospital admissions are important. Ambulatory continuous intravenous inotropes have been advocated by guidelines for such a purpose. We sought to determine the effect of intravenous dobutamine on symptomatic status, hospital stay, mortality, and cost expenditure. All consecutive end-stage heart failure patients not amenable for advanced therapies and discharged with continuous intravenous home dobutamine from a single tertiary centre between April 2011 and January 2017 were retrospectively analysed. Dobutamine (fixed dose) was infused through a single-lumen central venous catheter with a small pump that was refilled by a nurse on a daily basis. Symptomatic status was longitudinally assessed as the change in New York Heart Association class and patient global assessment scale. Antecedent and incident heart failure hospitalizations were determined in a paired fashion, and cost impact was assessed. A total of 21 patients (age 77 ± 9 years) were followed up for 869 ± 647 days. At first follow-up (6 ± 1 weeks) after the initiation of dobutamine, patients had a significant improvement in New York Heart Association class (-1.29 ± 0.64; P heart failure hospitalizations assessed at 3, 6, and 12 months were significantly reduced (P heart failure hospitalizations over the same time period. Cost expenditure was significantly lower at 3 (P heart failure is feasible and associated with improved symptomatic status, heart failure hospitalizations, and health-care-related costs. Nevertheless, results should be interpreted in the context of the small and retrospective design. Larger studies are necessary to evaluate the effect of dobutamine in palliative end-stage heart failure. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

  4. Enhancement of weld failure and tube ejection model in PENTAP program

    International Nuclear Information System (INIS)

    Jung, Jaehoon; An, Sang Mo; Ha, Kwang Soon; Kim, Hwan Yeol

    2014-01-01

    The reactor vessel pressure, the debris mass, the debris temperature, and the component of material can have an effect on the penetration tube failure modes. Furthermore, these parameters are interrelated. There are some representative severe accident codes such as MELCOR, MAAP, and PENTAP program. MELCOR decides on a penetration tube failure by its failure temperature such as 1273K simply. MAAP considers all penetration failure modes and has the most advanced model for a penetration tube failure model. However, the validation work against the experimental data is very limited. PENTAP program which evaluates the possible penetration tube failure modes such as creep failure, weld failure, tube ejection, and a long term tube failure under given accident condition was developed by KAERI. The experiment for the tube ejection is being performed by KAERI. The temperature distribution and the ablation rate of both weld and lower vessel wall can be obtained through the experiment. This paper includes the updated calculation steps for the weld failure and the tube ejection modes of the PENTAP program to apply the experimental results. PENTAP program can evaluate the possible penetration tube failure modes. It still requires a large amount of efforts to increase the prediction of failure modes. Some calculation steps are necessary for applying the experimental and the numerical data in the PENTAP program. In this study, new calculation steps are added to PENTAP program to enhance the weld failure and tube ejection models using KAERI's experimental data which are the ablation rate and temperature distribution of weld and lower vessel wall

  5. Comparison of performance of various tumour response criteria in assessment of regorafenib activity in advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib.

    Science.gov (United States)

    Shinagare, Atul B; Jagannathan, Jyothi P; Kurra, Vikram; Urban, Trinity; Manola, Judith; Choy, Edwin; Demetri, George D; George, Suzanne; Ramaiya, Nikhil H

    2014-03-01

    To compare performance of various tumour response criteria (TRCs) in assessment of regorafenib activity in patients with advanced gastrointestinal stromal tumour (GIST) with prior failure of imatinib and sunitinib. Twenty participants in a phase II trial received oral regorafenib (median duration 47 weeks; interquartile range (IQR) 24-88) with computed tomography (CT) imaging at baseline and every two months thereafter. Tumour response was prospectively determined on using Response Evaluation Criteria in Solid Tumours (RECIST) 1.1, and retrospectively reassessed for comparison per RECIST 1.0, World Health Organization (WHO) and Choi criteria, using the same target lesions. Clinical benefit rate [CBR; complete or partial response (CR or PR) or stable disease (SD)≥16 weeks] and progression-free survival (PFS) were compared between various TRCs using kappa statistics. Performance of TRCs in predicting overall survival (OS) was compared by comparing OS in groups with progression-free intervals less than or greater than 20 weeks by each TRC using c-statistics. PR was more frequent by Choi (90%) than RECIST 1.1, RECIST 1.0 and WHO (20% each), however, CBR was similar between various TRCs (overall CBR 85-90%, 95-100% agreement between all TRC pairs). PFS per RECIST 1.0 was similar to RECIST 1.1 (median 44 weeks versus 58 weeks), and shorter for WHO (median 34 weeks) and Choi (median 24 weeks). With RECIST 1.1, RECIST 1.0 and WHO, there was moderate concordance between PFS and OS (c-statistics 0.596-0.679). Choi criteria had less favourable concordance (c-statistic 0.506). RECIST 1.1 and WHO performed somewhat better than Choi criteria as TRC for response evaluation in patients with advanced GIST after prior failure on imatinib and sunitinib. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Heart failure among Indigenous Australians: a systematic review

    Directory of Open Access Journals (Sweden)

    Woods John A

    2012-11-01

    suggest that undiagnosed cases may be common in this population. In order to optimise management and to inform policy, high quality research on heart failure in Indigenous Australians is required to delineate accurate epidemiological indicators and to appraise health service provision.

  7. Nuclear energy policy in the Netherlands: short account of a failure

    International Nuclear Information System (INIS)

    Ramaer, H.

    1975-01-01

    It is argued that the predicted advantages of nuclear energy did not come forth: no profits, hardly any increase of employment and no cheaper electricity. The economic losses are paid by public funds while the disadvantages are neglected. The political aspects of this policy are discussed

  8. Human factors survey of advanced instrumentation and controls technologies in nuclear plants

    International Nuclear Information System (INIS)

    Carter, R.J.

    1992-01-01

    A survey of advanced instrumentation and controls (I ampersand C) technologies and associated human factors issues in the US and Canadian nuclear industries was carried out by a team from Oak Ridge national laboratory to provide background for the development of regulatory policy, criteria, and guides for review of advanced I ampersand C systems as well as human engineering guidelines for evaluating these systems. The survey found those components of the US nuclear industry surveyed to be quite interested in advanced I ampersand C, but very cautious in implementing such systems in nuclear facilities and power plants. The trend in the facilities surveyed is to experiment cautiously when there is an intuitive advantage or short-term payoff. In the control room, the usual practice is direct substitution of digital and microprocessor-based instruments or systems that are functionally identical to the analog instruments or systems being replaced. The most advanced I ampersand C systems were found in the Canadian CANDU plants, where the newest plant has digital system in almost 100% of its control systems and in over 70% of its plant protection system. The hypothesis that properly 'introducing digital systems increases safety' is supported by the Canadian experience. The performance of these digital systems was achieved using an appropriate quality assurance program for the software development. The ability of digital systems to detect impending failures and initiate a fail-safe action, is a significant safety issue that should be of special interest to every US utility as well as to the US Nuclear Regulatory Commission. (orig.)

  9. An Analysis of States' Policies Regarding Social Media Use in Education

    Science.gov (United States)

    Miller, Janette K.

    2016-01-01

    This policy analysis project focused on states' policies regarding social media use in education. Currently, policies, practices and laws are not keeping pace with the rapidly changing nature of technology. As a result of the quick advancement of social media practices, the need exists for organic policies and practices within the educational…

  10. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumor after failure with imatinib and sunitinib treatment: A meta-analysis.

    Science.gov (United States)

    Zhang, Zhenan; Jiang, Tao; Wang, Wensheng; Piao, Daxun

    2017-12-01

    This meta-analysis aimed to evaluate the safety and efficacy of regorafenib as a treatment for patients with advanced (metastatic and/or unresectable) gastrointestinal stromal tumor (AGIST) after developing resistance to imatinib and sunitinib. A literature search of databases such as PubMed, Embase, and Cochrane library was conducted up to February 2017. The pooled percentages and the corresponding 95% confidence intervals (CIs) were calculated using the Stata 11.0 software. Four studies involving 243 patients with AGIST were included. Results revealed that approximately 49% (95% CI 30-67), 14% (95% CI 5-23), and 41% (95% CI 21-61) of patients with AGIST showed clinical benefit (including complete response), partial response, and stable disease, respectively, after regorafenib treatment, which was given after failure with imatinib and sunitinib treatments. No complete response was found in the included studies. Pooled progression-free survival was 6.58 months (95% CI 4.62-8.54). Hypertension (20%; 95% CI 7-33), hand-foot skin reaction (22%; 95% CI 17-27), and hypophosphatemia (18%; 95% CI 5-41) were common grade ≥3 regorafenib-related adverse events in patients treated with regorafenib after failure with imatinib and sunitinib treatments. Forty-nine per cent of patients with AGIST benefited after regorafenib treatment after the development of resistance to imatinib and sunitinib. More studies should be performed to improve the clinical survival of patients with AGIST. Close monitoring and appropriate management of grade ≥3 regorafenib-related adverse events should be considered during treatment.

  11. Human resources for health policies: a critical component in health policies

    Directory of Open Access Journals (Sweden)

    Dussault Gilles

    2003-04-01

    Full Text Available Abstract In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM; a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM. There are three broad arguments for modernizing the ways in which human resources for health are managed: • the central role of the workforce in the health sector; • the various challenges thrown up by health system reforms; • the need to anticipate the effect on the health workforce (and consequently on service provision arising from various macroscopic social trends impinging on health systems. The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs. Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH: • to move beyond the traditional approach of personnel administration to a more global concept of HRM; • to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy; • to foster a more proactive attitude among human resources (HR policy-makers and managers; • to promote the full commitment of all professionals and sectors in all phases of the process. The development of explicit human resources

  12. NESTEM-QRAS: A Tool for Estimating Probability of Failure

    Science.gov (United States)

    Patel, Bhogilal M.; Nagpal, Vinod K.; Lalli, Vincent A.; Pai, Shantaram; Rusick, Jeffrey J.

    2002-10-01

    An interface between two NASA GRC specialty codes, NESTEM and QRAS has been developed. This interface enables users to estimate, in advance, the risk of failure of a component, a subsystem, and/or a system under given operating conditions. This capability would be able to provide a needed input for estimating the success rate for any mission. NESTEM code, under development for the last 15 years at NASA Glenn Research Center, has the capability of estimating probability of failure of components under varying loading and environmental conditions. This code performs sensitivity analysis of all the input variables and provides their influence on the response variables in the form of cumulative distribution functions. QRAS, also developed by NASA, assesses risk of failure of a system or a mission based on the quantitative information provided by NESTEM or other similar codes, and user provided fault tree and modes of failure. This paper will describe briefly, the capabilities of the NESTEM, QRAS and the interface. Also, in this presentation we will describe stepwise process the interface uses using an example.

  13. NESTEM-QRAS: A Tool for Estimating Probability of Failure

    Science.gov (United States)

    Patel, Bhogilal M.; Nagpal, Vinod K.; Lalli, Vincent A.; Pai, Shantaram; Rusick, Jeffrey J.

    2002-01-01

    An interface between two NASA GRC specialty codes, NESTEM and QRAS has been developed. This interface enables users to estimate, in advance, the risk of failure of a component, a subsystem, and/or a system under given operating conditions. This capability would be able to provide a needed input for estimating the success rate for any mission. NESTEM code, under development for the last 15 years at NASA Glenn Research Center, has the capability of estimating probability of failure of components under varying loading and environmental conditions. This code performs sensitivity analysis of all the input variables and provides their influence on the response variables in the form of cumulative distribution functions. QRAS, also developed by NASA, assesses risk of failure of a system or a mission based on the quantitative information provided by NESTEM or other similar codes, and user provided fault tree and modes of failure. This paper will describe briefly, the capabilities of the NESTEM, QRAS and the interface. Also, in this presentation we will describe stepwise process the interface uses using an example.

  14. The Use of Remote Sensing Data for Advancing America's Energy Policy

    Science.gov (United States)

    Valinia, Azita; Seery, Bernard D.

    2010-01-01

    After briefly reviewing America's Energy Policy laid out by the Obama Administration, we outline how a Global Carbon Observing System designed to monitor Carbon from space can provide the necessary data and tools to equip decision makers with the knowledge necessary to formulate effective energy use and practices policy. To stabilize greenhouse gas emissions in the atmosphere in a manner that it does not interfere with the Earth's climate system (which is one of the goals of United Nations Framework for Convention on Climate Change) requires vastly improved prediction of the atmospheric carbon dioxide (CO2) concentrations. This in torn requires a robust understanding of the carbon exchange mechanisms between atmosphere, land, and oceans and a clear understanding of the sources and sinks (i.e. uptake and storage) of CO2. We discuss how the Carbon Observing System from space aids in better understanding of the connection between the carbon cycle and climate change and provides more accurate predictions of atmospheric CO2 concentration. It also enables implementation of greenhouse gas (GHG) mitigation policies such as cap and trade programs, international climate treaties, as well as formulation of effective energy use policies.

  15. Advancing high-speed rail policy in the United States.

    Science.gov (United States)

    2012-06-01

    This report builds on a review of international experience with high-speed rail projects to develop recommendations for a High-speed rail policy framework for the United States. The international review looked at the experience of Korea, Taiwan, Chin...

  16. Harmonisation of European Migration Policies: The Failure of Immigration Control Policies in the Seventh and Eighth Decades of the 20th Century

    Directory of Open Access Journals (Sweden)

    Milan Mesić

    2003-12-01

    Full Text Available Until the middle of the 1970s, the migration policies of developed European countries were based on the assumption that controlling immigration was possible. Due to various reasons discussed in this article, such policies proved unsuccessful. The result was an increase in the total number of foreigners and a change in the composition of immigrant communities, i.e. the proportion of supported family members increased. During the 1980s there was increasing convergence in the migration policies of European immigration countries and traditional overseas emigration countries. Policies were more and more oriented towards preventing illegal migration flows, on regulating refugee flows and on balancing labour migration with family migration. The turning-point in the direction of “harmonising” West European migration policies was marked by the Schengen agreement (1985 on gradual elimination of border controls between the signing parties (France, Germany and the Benelux countries. Fear in the face of a possible invasion of Eastern Europeans after the collapse of socialism in 1989 was a further strong stimulus towards the harmonisation of migration policies in the developing EU. As opposed to migration control, the integration of immigrants has remained so far the prerogative of nation-states. The text further presents an overview of migration policy reforms in individual member states of the EU and of multilateral actions. The post-1989 migration regime in Europe has four major traits: 1 an extension of the agenda; 2 an accent on joint actions; 3 defensiveness; 4 confusion and an overload of issues. While on the one hand the EU continues to seek ways of protecting itself from undesired external migration, on the other hand the process of regional integration continues to “erase” its internal borders.

  17. Connection Management and Recovery Strategies under Epidemic Network Failures in Optical Transport Networks

    DEFF Research Database (Denmark)

    Fagertun, Anna Manolova; Ruepp, Sarah Renée

    2014-01-01

    The current trend in deploying automatic control plane solutions for increased flexibility in the optical transport layer leads to numerous advantages for both the operators and the customers, but also pose challenges related to the stability of the network and its ability to operate in a robust...... manner under attacks. This work proposes four policies for failure handling in a connection-oriented optical transport network, under Generalized MultiProtocol Label Switching control plane, and evaluates their performance under multiple correlated large-scale failures. We employ the Susceptible...... of their transport infrastructures. Applying proactive methods for avoiding areas where epidemic failures spread results in 50% less connections requiring recovery, which translates in improved quality of service to customers....

  18. A Critical Review of Landslide Failure Mechanisms

    Science.gov (United States)

    Stead, D.; Wolter, A.; Clague, J. J.

    2011-12-01

    During the last ten years several comprehensive geotechnical studies have been completed on major historic landslides including Randa in Switzerland, Frank in Canada, Aknes in Norway, La Clapiere in France and Vaiont in Italy. In addition, numerous researchers have documented deep-seated gravitational deformations and a wide variety of large prehistoric rock slope failures. The information provided by these studies is evidence of the significant advances made in our ability to map, monitor and model landslides. Over the same period, the mining industry has developed large open pits with slope heights exceeding 1000 m that provide important analogues to high mountain slopes. In this paper we analyse data from the literature to illustrate the importance of brittle fracture, 3D controls, anisotropy, overburden stress, geomorphic processes, groundwater and temperature in major landslides and provide some indicators as to the research required to further understand the complexity of rock slope failure mechanisms. The nature of the landslide failure surface has received inadequate attention in the past, with failure surfaces typically considered in 2D and simulated as discrete, smooth and often planar features. Current work shows that failure surfaces are inherently three-dimensional and have much structural variability across the area of the landslide scarp, reflecting complex structural histories. Such anisotropy and variations may result in multiple events or distinct blocks that move at different rates. Just as most failure surfaces vary spatially, they may also change with depth and thus should more realistically be considered failure zones rather than discrete surfaces. The increasing recognition of the importance of step-path failures, internal dilation and brittle fracture are indicative of the complexity in slope failure surfaces. Related to the variation in failure surface characteristics is the importance of 3D rotational displacements and both the

  19. European moves to a communal energy policy

    International Nuclear Information System (INIS)

    Klijs, K.

    1978-01-01

    The author has endeavoured to discover whether there is talk of a communal energy policy in the EEC and if so how far are the developments, on what foundation is the policy based and what factors are hindering its realisation. It is concluded that as yet there is scarely any talk of a communual energy policy within the activities of the EEC, although the growing dependence on oil imports is seen as a reason to discuss this policy. The main aim of such a policy is to reduce oil imports from 61% of energy sources in 1973 to 30% in 1985, since the oil from Arab lands is seen as a totally unreliable energy source. A very strong development in nuclear energy is seen as a means of reducing oil imports. The failure of a European energy policy cannot be blamed on the different conceptions of the member states. The choice against oil imports and for nuclear energy is general, and each member is initially trying to make the national energy provision safe. (C.F.)

  20. A Bayesian network approach for modeling local failure in lung cancer

    International Nuclear Information System (INIS)

    Oh, Jung Hun; Craft, Jeffrey; Al Lozi, Rawan; Vaidya, Manushka; Meng, Yifan; Deasy, Joseph O; Bradley, Jeffrey D; El Naqa, Issam

    2011-01-01

    Locally advanced non-small cell lung cancer (NSCLC) patients suffer from a high local failure rate following radiotherapy. Despite many efforts to develop new dose-volume models for early detection of tumor local failure, there was no reported significant improvement in their application prospectively. Based on recent studies of biomarker proteins' role in hypoxia and inflammation in predicting tumor response to radiotherapy, we hypothesize that combining physical and biological factors with a suitable framework could improve the overall prediction. To test this hypothesis, we propose a graphical Bayesian network framework for predicting local failure in lung cancer. The proposed approach was tested using two different datasets of locally advanced NSCLC patients treated with radiotherapy. The first dataset was collected retrospectively, which comprises clinical and dosimetric variables only. The second dataset was collected prospectively in which in addition to clinical and dosimetric information, blood was drawn from the patients at various time points to extract candidate biomarkers as well. Our preliminary results show that the proposed method can be used as an efficient method to develop predictive models of local failure in these patients and to interpret relationships among the different variables in the models. We also demonstrate the potential use of heterogeneous physical and biological variables to improve the model prediction. With the first dataset, we achieved better performance compared with competing Bayesian-based classifiers. With the second dataset, the combined model had a slightly higher performance compared to individual physical and biological models, with the biological variables making the largest contribution. Our preliminary results highlight the potential of the proposed integrated approach for predicting post-radiotherapy local failure in NSCLC patients.

  1. Carcinoma of Uterine Cervix Treated with High Dose Rate Intracavitary Irradiation : 1. Patterns of Failure

    International Nuclear Information System (INIS)

    Kim, Ok Bae; Choi, Tae Jin; Kim, Jin Hee

    1993-01-01

    226 patients with carcinoma of the uterine cervix treated with curative radiation therapy at the Department of Therapeutic Radiology, Dongsan hospital, Keimyung university, School of medicine, from July, 1988 to May, 1991 were evaluated. The patients with all stages of the disease were included in this study. The maximum and mean follow up durations were 60 and 43 months. The radiation therapy consisted of external irradiation to the whole pelvis (2700 - 4500 cGy) and boost parametrial doses(for a total of 4500 - 6300 cGy) with midline shill(4x10 cm), and combined with intracavitary irradiation irradiation(5700 - 7500 cGy to point A). The distribution of patients according to the stage was as follows: stage IB 37(16.4%), stage IIA 91 (40.3%), Stage IIB 58(25.7%), stage III 32(13.8%), stage IV 8 (3.5%). The overall failure rate was 23.9%(54 patients). The failure rate increased as a function of stage from 13.5% in stage 1B to 15.4% in stage IIA, 25.9% in stage IIB, 46.9% in stage III, and 62.5% in stage IV. The pelvic failure alone were 32 patients and 11 patients were as a components of other failure, and remaining 11 patients had distant metastasis only. Among the 43 patients of locoregional failure, 28 patients were not controlled initially and in other words nearly half of total failures were due to residual tumor. The mean medial paracervical(point A) doses were 6700 cGy in stage IIB, 7200 cGy in stage IIA, 7450 cGy in stage IIB, 7600 cGy in stage III and 8100 cGy in stage IV. The medial paracevical doses showed some correlation with tumor control rate in early stage of disease (stage Ib, IIA), but there were higher central failure rate in advanced stage in spite of higher paracervical doses. In advanced stage, failure were not reduced by simple Increment of paracervical doses. To improve a locoregional control rate in advanced stages, it is necessary to give additional treatment such as concomitant chemoradiation

  2. Neurodevelopmental and Cognitive Outcomes in Children With Intestinal Failure.

    Science.gov (United States)

    Chesley, Patrick M; Sanchez, Sabrina E; Melzer, Lilah; Oron, Assaf P; Horslen, Simon P; Bennett, F Curt; Javid, Patrick J

    2016-07-01

    Recent advances in medical and surgical management have led to improved long-term survival in children with intestinal failure. Yet, limited data exist on their neurodevelopmental and cognitive outcomes. The aim of the present study was to measure neurodevelopmental outcomes in children with intestinal failure. Children enrolled in a regional intestinal failure program underwent prospective neurodevelopmental and psychometric evaluation using a validated scoring tool. Cognitive impairment was defined as a mental developmental index Neurodevelopmental impairment was defined as cerebral palsy, visual or hearing impairment, or cognitive impairment. Univariate analyses were performed using the Wilcoxon rank-sum test. Data are presented as median (range). Fifteen children with a remnant bowel length of 18 (5-85) cm were studied at age 17 (12-67) months. Thirteen patients remained dependent on parenteral nutrition. Twelve (80%) subjects scored within the normal range on cognitive testing. Each child with cognitive impairment was noted to have additional risk factors independent of intestinal failure including cardiac arrest and extreme prematurity. On univariate analysis, cognitive impairment was associated with longer inpatient hospital stays, increased number of surgical procedures, and prematurity (P neurodevelopmental impairment. A majority of children with intestinal failure demonstrated normal neurodevelopmental and cognitive outcomes on psychometric testing. These data suggest that children with intestinal failure without significant comorbidity may be at low risk for long-term neurodevelopmental impairment.

  3. The Nabucco project's economic failure - Lessons for the European Union's foreign gas policy

    International Nuclear Information System (INIS)

    Finon, D.

    2010-01-01

    This article criticises the new strategy of the European Union's foreign gas policy. The new policy translates in the setting up of gas corridors to diversify importations in a context of increased political competition with Russia. The inherent limitations of the EU's plan to promote the Nabucco gas pipeline as merchant line without seeking exporter involvement in the project are analysed. Such limitations are analysed through various economic prospects. A micro-economic calculation shows the significance of the use rate of a gas pipeline for profitability. The competition theory shows the possibility for an existing dominating firm to compete with a newcomer's investment by building equipment likely to pre-empt access to the resources. The transaction cost saving shows how long term undertakings between producers and suppliers are necessary for the development of transit infrastructures and distant gas fields. The article ends with the need for economic relevance in the EU's gas policy actions. (author)

  4. A Competing Risk Model of First Failure Site after Definitive Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer.

    Science.gov (United States)

    Nygård, Lotte; Vogelius, Ivan R; Fischer, Barbara M; Kjær, Andreas; Langer, Seppo W; Aznar, Marianne C; Persson, Gitte F; Bentzen, Søren M

    2018-04-01

    The aim of the study was to build a model of first failure site- and lesion-specific failure probability after definitive chemoradiotherapy for inoperable NSCLC. We retrospectively analyzed 251 patients receiving definitive chemoradiotherapy for NSCLC at a single institution between 2009 and 2015. All patients were scanned by fludeoxyglucose positron emission tomography/computed tomography for radiotherapy planning. Clinical patient data and fludeoxyglucose positron emission tomography standardized uptake values from primary tumor and nodal lesions were analyzed by using multivariate cause-specific Cox regression. In patients experiencing locoregional failure, multivariable logistic regression was applied to assess risk of each lesion being the first site of failure. The two models were used in combination to predict probability of lesion failure accounting for competing events. Adenocarcinoma had a lower hazard ratio (HR) of locoregional failure than squamous cell carcinoma (HR = 0.45, 95% confidence interval [CI]: 0.26-0.76, p = 0.003). Distant failures were more common in the adenocarcinoma group (HR = 2.21, 95% CI: 1.41-3.48, p failure showed that primary tumors were more likely to fail than lymph nodes (OR = 12.8, 95% CI: 5.10-32.17, p failure (OR = 1.26 per unit increase, 95% CI: 1.12-1.40, p failure site-specific competing risk model based on patient- and lesion-level characteristics. Failure patterns differed between adenocarcinoma and squamous cell carcinoma, illustrating the limitation of aggregating them into NSCLC. Failure site-specific models add complementary information to conventional prognostic models. Copyright © 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

  5. The environmental policy of the EC. An analysis exemplified by air pollution abatement policy

    International Nuclear Information System (INIS)

    Caspari, S.

    1995-01-01

    Since the early seventies the European Community has reacted to increasing ecological damage with complex and comprehensive common environmental policies. In this study, the author analyzes and evaluates the theoretical conception and the instrumental application of the EC Environmental Policy using four criteria: (1) Ecological effectiveness, (2) economic efficiency, (3) conformity with a market order - viewpoint of 'Ordnungspolitik', (4) 'sustainability'. The study shows that there is a large discrepancy between the demands and the reality of the EC Environmental Policy. In addition to grave ecological deficiencies it reveals an increse in rent-seeking activities and an interventionist trend which have resulted in the erosion of the competitive incentive system of the market order in the Community. In view of various deficits the author perceives a basic 'regulation paradox' and a 'policy failure'. Based on a diagnosis of the causes of these deficiencies, he outlines some proposals for a reform of the EC Environmental Policy, indicating that a central prerequisite for a more effective and efficient environmental protection is a reorientation in the system ('Ordnungspolitik') which determines the common Environmental Policy. In addition, he maintains that in view of the clear asymmetry in the representation of interests in favour of particularist interests it is necessary to strengthen public interest in order to enable a more effective protection of the options future generations will have regarding their lives and their behaviour. (orig.) [de

  6. The theory of white elephants. A rational choice explanation of policy failures in government support for civilian technology

    International Nuclear Information System (INIS)

    Keck, O.

    1985-01-01

    Government programs for developing civilian technology sometimes end up in spectacular failures. This paper conceptualizes such failures as a pareto-deficient game, similar to the prisoner's dilemma. Firms expecting that a program is going to be a failure have no incentive to communicate their judgement to government, as long as government finances all development costs. Fortunately there is a way out of the dilemma. Cost-sharing between government and industry creates an incentive for the firms to communicate to government what they realy think of the technology's economic prospects. Empirical evidence is given from the history of the West German and American fast breeder programs. The paper discusses implications of this theory for the concept of government failure. (orig.HP) [de

  7. Success after Failure: Academic Effects and Psychological Implications of Early Universal Algebra Policies

    Science.gov (United States)

    Howard, Keith A.; Scott, Allison; Romero, Martin; Saddler, Derrick

    2015-01-01

    In this article, the authors use the High School Longitudinal Study 2009 (HSLS:09) national database to analyze the relationships between algebra failure, subsequent performance, motivation, and college readiness. Students who failed eighth-grade Algebra I did not differ significantly in mathematics proficiency from those who passed lower-level…

  8. Single-stage Kanban system with deterioration failures and condition-based preventive maintenance

    International Nuclear Information System (INIS)

    Xanthopoulos, A.S.; Koulouriotis, D.E.; Botsaris, P.N.

    2015-01-01

    Despite the fact that the fields of pull type production control policies and condition-based preventive maintenance have much in common contextually, they have evolved independently up to now. In this investigation, an attempt is made to bridge the gap between these two branches of knowledge by introducing the single-stage Kanban system with deterioration failures and condition-based preventive maintenance. The formalism of continuous time Markov chains is used to model the system and expressions for eight performance metrics are derived. Two important, from a managerial perspective, constrained optimization problems for the proposed model are defined where the objective is the simultaneous optimization of the Kanban policy, the preventive maintenance policy and the inspection schedule under conflicting performance criteria. Multiple instances of each optimization problem are solved by means of the augmented Lagrangian genetic algorithm. The results from the optimization trials coupled by the results from extensive numerical examples facilitate the thorough investigation of the system’s behaviour. - Highlights: • Kanban system with deterioration failures and preventive maintenance is introduced. • The system is modeled as a continuous time Markov chain. • Expressions for eight performance metrics are derived. • The behavior of the system is studied through numerical examples. • Optimization results for selected performance metrics are presented

  9. Avoiding Implementation Failure in Catchment Landscapes: A Case Study in Governance of the Great Barrier Reef.

    Science.gov (United States)

    Dale, Allan P; Vella, Karen; Gooch, Margaret; Potts, Ruth; Pressey, Robert L; Brodie, Jon; Eberhard, Rachel

    2017-10-04

    Water quality outcomes affecting Australia's Great Barrier Reef (GBR) are governed by multi-level and multi-party decision-making that influences forested and agricultural landscapes. With international concern about the GBR's declining ecological health, this paper identifies and focuses on implementation failure (primarily at catchment scale) as a systemic risk within the overall GBR governance system. There has been limited integrated analysis of the full suite of governance subdomains that often envelop defined policies, programs and delivery activities that influence water quality in the GBR. We consider how the implementation of separate purpose-specific policies and programs at catchment scale operate against well-known, robust design concepts for integrated catchment governance. We find design concerns within ten important governance subdomains that operate within GBR catchments. At a whole-of-GBR scale, we find a weak policy focus on strengthening these delivery-oriented subdomains and on effort integration across these subdomains within catchments. These governance problems when combined may contribute to failure in the implementation of major national, state and local government policies focused on improving water quality in the GBR, a lesson relevant to landscapes globally.

  10. Why has the introduction of natural gas vehicles failed in Germany?—Lessons on the role of market failure in markets for alternative fuel vehicles

    International Nuclear Information System (INIS)

    Peters von Rosenstiel, Dirk; Heuermann, Daniel F.; Hüsig, Stefan

    2015-01-01

    Despite private investments exceeding two billion Euros and tax incentives of more than 500 million Euros, the market share of natural gas vehicles (NGVs) in Germany has lagged far behind expectations and behind market developments in other countries. With total cost of ownership being on average lower for NGVs than for gasoline and diesel vehicles this raises the question of the existence of market failure in the German NGV-market. We use a case study approach where we combine quantitative data with insights from a multi-industry expert panel and in-depth interviews with experts from industry, government and civil society in order to examine whether and how different types of market failure contribute to the status quo in the German market for NGVs. We conclude that coordination failure in complementary markets, an artificially created monopoly of service stations at motorways, imperfect information, bounded consumer rationality, and principle-agent-problems are the most prominent market failures inhibiting the development of a functioning market for NGVs. Our results are instructive for the design of effective public policies and investor strategies aiming to create markets for alternative fuel vehicles. - Highlights: • We analyze market failure in the German market for natural gas vehicles. • Coordination failure is the most important reason for market failure to arise. • Minor factors: regulatory deficits, imperfect information, bounded rationality. • Policies encompass stabilizing expectations and supporting actor coordination. • Our results are instructive for policies and investor strategies in AFV-markets

  11. Value of adding the renal pathological score to the kidney failure risk equation in advanced diabetic nephropathy.

    Directory of Open Access Journals (Sweden)

    Masayuki Yamanouchi

    Full Text Available There have been a limited number of biopsy-based studies on diabetic nephropathy, and therefore the clinical importance of renal biopsy in patients with diabetes in late-stage chronic kidney disease (CKD is still debated. We aimed to clarify the renal prognostic value of pathological information to clinical information in patients with diabetes and advanced CKD.We retrospectively assessed 493 type 2 diabetics with biopsy-proven diabetic nephropathy in four centers in Japan. 296 patients with stage 3-5 CKD at the time of biopsy were identified and assigned two risk prediction scores for end-stage renal disease (ESRD: the Kidney Failure Risk Equation (KFRE, a score composed of clinical parameters and the Diabetic Nephropathy Score (D-score, a score integrated pathological parameters of the Diabetic Nephropathy Classification by the Renal Pathology Society (RPS DN Classification. They were randomized 2:1 to development and validation cohort. Hazard Ratios (HR of incident ESRD were reported with 95% confidence interval (CI of the KFRE, D-score and KFRE+D-score in Cox regression model. Improvement of risk prediction with the addition of D-score to the KFRE was assessed using c-statistics, continuous net reclassification improvement (NRI, and integrated discrimination improvement (IDI.During median follow-up of 1.9 years, 194 patients developed ESRD. The cox regression analysis showed that the KFRE,D-score and KFRE+D-score were significant predictors of ESRD both in the development cohort and in the validation cohort. The c-statistics of the D-score was 0.67. The c-statistics of the KFRE was good, but its predictive value was weaker than that in the miscellaneous CKD cohort originally reported (c-statistics, 0.78 vs. 0.90 and was not significantly improved by adding the D-score (0.78 vs. 0.79, p = 0.83. Only continuous NRI was positive after adding the D-score to the KFRE (0.4%; CI: 0.0-0.8%.We found that the predict values of the KFRE and the D

  12. Value of adding the renal pathological score to the kidney failure risk equation in advanced diabetic nephropathy.

    Science.gov (United States)

    Yamanouchi, Masayuki; Hoshino, Junichi; Ubara, Yoshifumi; Takaichi, Kenmei; Kinowaki, Keiichi; Fujii, Takeshi; Ohashi, Kenichi; Mise, Koki; Toyama, Tadashi; Hara, Akinori; Kitagawa, Kiyoki; Shimizu, Miho; Furuichi, Kengo; Wada, Takashi

    2018-01-01

    There have been a limited number of biopsy-based studies on diabetic nephropathy, and therefore the clinical importance of renal biopsy in patients with diabetes in late-stage chronic kidney disease (CKD) is still debated. We aimed to clarify the renal prognostic value of pathological information to clinical information in patients with diabetes and advanced CKD. We retrospectively assessed 493 type 2 diabetics with biopsy-proven diabetic nephropathy in four centers in Japan. 296 patients with stage 3-5 CKD at the time of biopsy were identified and assigned two risk prediction scores for end-stage renal disease (ESRD): the Kidney Failure Risk Equation (KFRE, a score composed of clinical parameters) and the Diabetic Nephropathy Score (D-score, a score integrated pathological parameters of the Diabetic Nephropathy Classification by the Renal Pathology Society (RPS DN Classification)). They were randomized 2:1 to development and validation cohort. Hazard Ratios (HR) of incident ESRD were reported with 95% confidence interval (CI) of the KFRE, D-score and KFRE+D-score in Cox regression model. Improvement of risk prediction with the addition of D-score to the KFRE was assessed using c-statistics, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). During median follow-up of 1.9 years, 194 patients developed ESRD. The cox regression analysis showed that the KFRE,D-score and KFRE+D-score were significant predictors of ESRD both in the development cohort and in the validation cohort. The c-statistics of the D-score was 0.67. The c-statistics of the KFRE was good, but its predictive value was weaker than that in the miscellaneous CKD cohort originally reported (c-statistics, 0.78 vs. 0.90) and was not significantly improved by adding the D-score (0.78 vs. 0.79, p = 0.83). Only continuous NRI was positive after adding the D-score to the KFRE (0.4%; CI: 0.0-0.8%). We found that the predict values of the KFRE and the D-score were

  13. The cost of policy simplification in conservation incentive programs

    DEFF Research Database (Denmark)

    Armsworth, Paul R.; Acs, Szvetlana; Dallimer, Martin

    2012-01-01

    of biodiversity. Common policy simplifications result in a 49100% loss in biodiversity benefits depending on the conservation target chosen. Failure to differentiate prices for conservation improvements in space is particularly problematic. Additional implementation costs that accompany more complicated policies......Incentive payments to private landowners provide a common strategy to conserve biodiversity and enhance the supply of goods and services from ecosystems. To deliver cost-effective improvements in biodiversity, payment schemes must trade-off inefficiencies that result from over-simplified policies...... with the administrative burden of implementing more complex incentive designs. We examine the effectiveness of different payment schemes using field parameterized, ecological economic models of extensive grazing farms. We focus on profit maximising farm management plans and use bird species as a policy-relevant indicator...

  14. Patient Engagement and Patient-Centred Care in the Management of Advanced Chronic Kidney Disease and Chronic Kidney Failure

    Directory of Open Access Journals (Sweden)

    Robert Allan Bear

    2014-10-01

    Full Text Available Purpose: The purpose of this article is to review the current status of patient-centred care (PCC and patient engagement (PE in the management of patients with advanced chronic kidney disease (CKD and end-stage renal disease (ESRD, to identify some of the barriers that exist to the achievement of PCC and PE, and to describe how these barriers can be overcome. Sources of information: The review is based on the professional experience of one of the authors (RB as a Nephrologist and health care consultant, on the MBA thesis of one of the authors (SS and on a review of pertinent internet-based information and published literature. Findings: Evidence exists that, currently, the care of patients with advanced CKD and ESRD is not fully patient-centred or fully supportive of PE. A number of barriers exist, including: conflict with other priorities; lack of training and fear of change; the unequal balance of power between patients and providers; physician culture and behaviour; the fee-for-service model of physician compensation; slow implementation of electronic health records; and, fear of accountability. These barriers can be overcome by committed leadership and the development of an information-based implementation plan. Established Renal Agencies in Canada appear interested in facilitating this work by collaborating in the development of a toolkit of recommended educational resources and preferred implementation practices for use by ESRD Programs. Limitations: A limitation of this review is the absence of a substantial pre-existing literature on this topic. Implications: Receiving care that is patient-centred and that promotes PE benefits patients with serious chronic diseases such as advanced CKD and ESRD. Considerable work is required by ESRD Programs to ensure that such care is provided. Canadian Renal Agencies can play an important role by ensuring that ESRD Programs have access to essential educational material and proven implementation

  15. 'Shovel-Ready' applications of stem cell advances for pediatric heart disease.

    Science.gov (United States)

    Files, Matthew D; Boucek, Robert J

    2012-10-01

    The past decade has seen remarkable advances in the field of stem cell biology. Many new technologies and applications are passing the translational phase and likely will soon be relevant for the clinical pediatric cardiologist. This review will focus on two advances in basic science that are now translating into clinical trials. The first advance is the recognition, characterization, and recent therapeutic application of resident cardiac progenitor cells (CPCs). Early results of adult trials and scattered case reports in pediatric patients support expanding CPC-based trials for end-stage heart failure in pediatric patients. The relative abundance of CPCs in the neonate and young child offers greater potential benefits in heart failure treatment than has been realized to date. The second advance is the technology of induced pluripotent stem cells (iPSCs), which reprograms differentiated somatic cells to an undifferentiated embryonic-like state. When iPSCs are differentiated into cardiomyocytes, they model a patient's specific disease, test pharmaceuticals, and potentially provide an autologous source for cell-based therapy. The therapeutic recruitment and/or replacement of CPCs has potential for enhancing cardiac repair and regeneration in children with heart failure. Use of iPSCs to model heart disease holds great potential to gain new insights into diagnosis, pathophysiology, and disease-specific management for genetic-based cardiovascular diseases that are prevalent in pediatric patients.

  16. Reliability analysis for dynamic configurations of systems with three failure modes

    International Nuclear Information System (INIS)

    Pham, Hoang

    1999-01-01

    Analytical models for computing the reliability of dynamic configurations of systems, such as majority and k-out-of-n, assuming that units and systems are subject to three types of failures: stuck-at-0, stuck-at-1, and stuck-at-x are presented in this paper. Formulas for determining the optimal design policies that maximize the reliability of dynamic k-out-of-n configurations subject to three types of failures are defined. The comparisons of the reliability modeling functions are also obtained. The optimum system size and threshold value k that minimize the expected cost of dynamic k-out-of-n configurations are also determined

  17. Flexural Progressive Failure of Carbon/Glass Interlayer and Intralayer Hybrid Composites.

    Science.gov (United States)

    Wang, Qingtao; Wu, Weili; Gong, Zhili; Li, Wei

    2018-04-17

    The flexural progressive failure modes of carbon fiber and glass fiber (C/G) interlayer and intralayer hybrid composites were investigated in this work. Results showed that the bending failure modes for interlayer hybrid composites are determined by the layup structure. Besides, the bending failure is characterized by the compression failure of the upper layer, when carbon fiber tends to distribute in the upper layer, the interlayer hybrid composite fails early, the failure force is characterized by a multi-stage slightly fluctuating decline and the fracture area exhibits a diamond shape. While carbon fiber distributes in the middle or bottom layer, the failure time starts late, and the failure process exhibits one stage sharp force/stress drop, the fracture zone of glass fiber above the carbon layers presents an inverted trapezoid shape, while the fracture of glass fiber below the carbon layers exhibits an inverted triangular shape. With regards to the intralayer hybrid composites, the C/G hybrid ratio plays a dominating role in the bending failure which could be considered as the mixed failures of four structures. The bending failure of intralayer hybrid composites occurs in advance since carbon fiber are located in each layer; the failure process shows a multi-stage fluctuating decline, and the decline slows down as carbon fiber content increases, and the fracture sound release has the characteristics of a low intensity and high frequency for a long time. By contrast, as glass fiber content increases, the bending failure of intralayer composites is featured with a multi-stage cliff decline with a high amplitude and low frequency for a short-time fracture sound release.

  18. Policy analysis: palliative care in Ireland.

    LENUS (Irish Health Repository)

    Larkin, P

    2014-03-01

    Palliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the \\'policy analysis triangle\\' as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation.

  19. Developing of a software for determining advanced brake failures in brakes test bench

    Directory of Open Access Journals (Sweden)

    Hakan Köylü

    2016-08-01

    Full Text Available At present time, the brake test bench conducts the braking and suspension tests of front or rear axles and the test results are evaluated through one axle. The purpose of the brake testing system is to determine braking force and damping coefficient dissymmetry of one axle. Thus, this test system evaluates the performance of service brake, hand brake and suspension systems by considering separately front and rear axle dissymmetry. For this reason, the effects of different braking and damping forces applied by right and left wheels of both axles on braking performance of all vehicle are not determined due to available algorithm of the test bench. Also, the other brake failures are not occurred due to the algorithm of brake test system. In this study, the interface has been developed to determine the other effects of dissymmetry and the other brake failures by using the one axle results of brake test bench. The interface has algorithm computing the parameters according to the interaction between front and rear axles by only using measured test results. Also, it gives the warnings by comparing changes in the parameters with braking performance rules. Braking and suspension tests of three different vehicles have been conducted by using brake test bench to determine the performance of the algorithm. Parameters based on the axle interaction have been calculated by transferring brake test results to the interface and the test results have been evaluated. As a result, the effects of brake and suspension failures on braking performance of both axle and vehicle have been determined thanks to the developed interface.

  20. Detection of instrument or component failures in a nuclear plant by Luenberger observers

    International Nuclear Information System (INIS)

    Wilburn, N.P.; Colley, R.W.; Alexandro, F.J.; Clark, R.N.

    1985-01-01

    A diagnostic system, which will distinguish between instrument failures (flowmeters, etc.) and component failures (valves, filters, etc.) that show the same symptoms, has been developed for nuclear Plants using Luenberger observers. Luenberger observers are online computer based modules constructed following the technology of Clark [3]. A seventh order model of an FFTF subsystem was constructed using the Advanced Continuous Simulation Language (ACSL) and was used to show through simulation that Luenberger observers can be applied to nuclear systems

  1. The classroom, an inadequate mechanism for advancing diversity ...

    African Journals Online (AJOL)

    In the interest of instilling a respect for diversity in learners, the South African policy on religion and education (DoE 2003) aims to recognise religion in teaching and learning in public schools. The policy provides one mechanism for advancing diversity via religion education; Life Orientation in the classroom. Research ...

  2. Academic Failure and Child-to-Parent Violence: Family Protective Factors.

    Science.gov (United States)

    Ibabe, Izaskun

    2016-01-01

    A reduction in academic achievement over the course of adolescence has been observed. School failure is characterized by difficulties to teaching school goals. A variety of other behavioral problems are often associated with school failure. Child-to-parent violence has been associated with different school problems. The main objective of current study was to examine the contribution of family variables (parental education level, family cohesion, and positive family discipline) on academic failure and child-to-parent violence of adolescents from a community sample. Moreover, a goal was to explore if academic failure was a valid predictor of child-to-parent violence. To this end, it has been developed a comprehensive statistical model through Structural Equation Modeling (SEM). Participants were 584 children from eight secondary schools in the Basque Country (Spain) and aged between 12 and 18. Among other scales Conflict Tactics Scale and Family Environment Scale were administrated for measuring child-to-parent violence and family cohesion environment, respectively. The structural model revealed that parental education level is a relevant protective factor against academic failure. Positive family discipline (inductive discipline, supervision, and penalty) show a significant association with child-to-parent violence and academic failure. Disciplinary practices could be more efficient to prevent child-to-parent violence or school failure if children perceive a positive environment in their home. However, these findings could be explained by inverse causality, because some parents respond to child-to-parent violence or academic failure with disciplinary strategies. School failure had indirect effects on child-to-parent violence through family cohesion. For all that, education policies should focus on parental education courses for disadvantaged families in order to generate appropriate learning environments at home and to foster improvement of parent

  3. Responding to Crop Failure: Understanding Farmers’ Coping Strategies in Southern Malawi

    Directory of Open Access Journals (Sweden)

    Jeanne Y. Coulibaly

    2015-02-01

    Full Text Available Malawi is a country in southern Africa facing high climate variability and many agricultural challenges. This paper examines farmers’ coping strategies for crop failure and the determinants of their choices using household level data from rural southern Malawi. The results highlight that farmers are not responding directly to climate variability, but to crop failure, which is influenced by climate stress, as well as other constraints, such as poor soil fertility and lack of agricultural inputs and technologies. The coping strategies adopted by households are mostly ex-post measures, including engaging in casual labor, small businesses and the sale of forest products. The main determinants of the adoption of these coping options are education, gender of the head of household, soil fertility and frequency of crop failure. This study concludes by recommending, among other things, that policies for the more efficient communication of climate change threats should emphasize the risk of crop failure. Furthermore, initiatives to assist households to better cope with climate change should take into consideration the local context of decision-making which is shaped by multiple stressors.

  4. Achieving Prudent Dementia Care (Palliare: An International Policy and Practice Imperative

    Directory of Open Access Journals (Sweden)

    Debbie Tolson

    2016-12-01

    Full Text Available This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care ('Palliare', that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities

  5. Environment and economy: Property rights and public policy

    International Nuclear Information System (INIS)

    Bromley, D.J.

    1991-01-01

    For much of its history, environmental economics has sought to modify public policy in order to achieve efficient use and management of environmental resources. The results of this attempt, however, have been dismaying for the most part, and environment public policy continues to differ from the course of action prescribed by economic analysis. Some economists have begun to acknowledge that the reasons for this gap between economic theory and public policy may lie in environmental economics itself rather than in poor policy choices. That is the message sent in this book by Daniel Bromley, who joins S.V. Ciriacy-Wantrup, Allan Schmid, and others in a strong internal critique of the discipline and, in particular, of the 'property rights school' of Coase, Demsetz, and other advocates of the market. Property rights are the common thread of this critique, which blames much of the failure of environmental economics to influence environmental policy on several fundamental misconceptions regarding property

  6. (Re)Thinking the Adoption of Inclusive Education Policy in Ontario Schools

    Science.gov (United States)

    Massouti, Ayman

    2018-01-01

    The purpose of this article is to advance a proposal for the analysis of how inclusive education policies in Ontario schools are adopted. In particular, I use the notion of "Policy Enactment" to re-conceptualize the processes of putting inclusive education policies into practice. The argument is that the traditional…

  7. Tiered Licensure: Connecting Educator Effectiveness Policies. Ask the Team

    Science.gov (United States)

    Paliokas, Kathleen

    2013-01-01

    Multitiered licensure structures can provide educators incentives to develop and improve their performance as they work toward advanced status. When working in tandem with compensation, career ladders, and ongoing professional learning policies, licensure can be a lever to promote educator development, advancement, and retention. Licensure…

  8. Philosophy, policies, and procedures - The three P's of flight-deck operations

    Science.gov (United States)

    Degani, Asaf; Wiener, Earl L.

    1991-01-01

    Standard operating procedures are drafted and provided to flightcrews to dictate the manner in which tasks are carried out. Failure to conform to Standard Operating Procedures (SOP) is frequently listed as the cause of violations, incidents, and accidents. However, procedures are often designed piecemeal, rather than being based on a sound philosophy of operations and policies that follow from such a philosophy. A framework of philosophy, policies, and procedures is proposed.

  9. Canada's nuclear export policy

    Energy Technology Data Exchange (ETDEWEB)

    Morrison, R W; Wonder, E F [Carleton Univ., Ottawa, Ontario (Canada)

    1978-01-01

    The factors influencing the evolution of Canada's nuclear export policy are examined. Initially, nuclear technology was exported to establish an industry in Canada and to share the technology with other countries. After 1974 an increasingly broad range of political and social factors were taken into account and safeguards became the dominant factor. The indirect impacts of the new policy fall into two groups. One consists of the effects of Canada's leadership in taking a tough stand on safeguards. The second group of effects involve the concern of other countries about access to secure energy supplies and advanced technology.

  10. Canada's nuclear export policy

    International Nuclear Information System (INIS)

    Morrison, R.W.; Wonder, E.F.

    1978-01-01

    The factors influencing the evolution of Canada's nuclear export policy are examined. Initially, nuclear technology was exported to establish an industry in Canada and to share the technology with other countries. After 1974 an increasingly broad range of political and social factors were taken into account and safeguards became the dominant factor. The indirect impacts of the new policy fall into two groups. One consists of the effects of Canada's leadership in taking a tough stand on safeguards. The second group of effects involve the concern of other countries about access to secure energy supplies and advanced technology. (O.T.)

  11. Proceedings of GLOBAL 2007 conference on advanced nuclear fuel cycles and systems

    International Nuclear Information System (INIS)

    2007-01-01

    In keeping with the 12-year history of this conference, GLOBAL 2007 focuses on future nuclear energy systems and fuel cycles. With the increasing public acceptance and political endorsement of nuclear energy, it is a pivotal time for nuclear energy research. Significant advances have been made in development of advanced nuclear fuels and materials, reactor designs, partitioning, transmutation and reprocessing technologies, and waste management strategies. In concert with the technological advances, it is more important than ever to develop sensible nuclear proliferation policies, to promote sustainability, and to continue to increase international collaboration. To further these aims, GLOBAL 2007 highlights recent developments in the following areas: advanced integrated fuel cycle concepts, spent nuclear fuel reprocessing, advanced reprocessing technology, advanced fuels and materials, advanced waste management technology, novel concepts for waste disposal and repository development, advanced reactors, partitioning and transmutation, developments in nuclear non-proliferation technology, policy, and implementation, sustainability and expanded global utilization of nuclear energy, and international collaboration on nuclear energy

  12. Early predictors of success of non-invasive positive pressure ventilation in hypercapnic respiratory failure.

    Science.gov (United States)

    Bhattacharyya, D; Prasad, Bnbm; Tampi, P S; Ramprasad, R

    2011-10-01

    Non-invasive positive pressure ventilation (NIPPV) has emerged as a significant advancement in the management of acute hypercapnic respiratory failure. Patients with hypercapnic respiratory failure requiring ventilation therapy (respiratory rate [RR] of > 30 breaths per minutes, PaCO2 > 55 mmHg and arterial pH success group and these parameters continued to improve even after four and 24 hours of NIPPV treatment. Out of 24 (24%) patients who failed to respond, 13 (54%) needed endotracheal intubation within one hour. The failure group had higher baseline HR than the success group. Improvement in HR, RR, pH, and PCO2 one hour after putting the patient on NIPPV predicts success of non-invasive positive pressure ventilation in hypercapnic respiratory failure.

  13. Right ventricular longitudinal strain correlates well with right ventricular stroke work index in patients with advanced heart failure referred for heart transplantation.

    Science.gov (United States)

    Cameli, Matteo; Lisi, Matteo; Righini, Francesca Maria; Tsioulpas, Charilaos; Bernazzali, Sonia; Maccherini, Massimo; Sani, Guido; Ballo, Piercarlo; Galderisi, Maurizio; Mondillo, Sergio

    2012-03-01

    Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and success of using left ventricular assist devices (LVADs) in patients with refractory heart failure. Tissue Doppler and M-mode measurements of tricuspid systolic motion (tricuspid S' and tricuspid annular plane systolic excursion [TAPSE]) are the most currently used methods for the quantification of RV longitudinal function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of global RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed at exploring the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) in patients referred for cardiac transplantation. Right-side heart catheterization and transthoracic echo Doppler were simultaneously performed in 41 patients referred for cardiac transplantation evaluation for advanced systolic heart failure. Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging all segments in apical 4-chamber view (global RVLS) and by averaging RV free-wall segments (free-wall RVLS). Tricuspid S' and TAPSE were also calculated. No significant correlations were found for TAPSE or tricuspid S' with RVSWI (r = 0.14; r = 0.06; respectively). Close negative correlations between global RVLS and free-wall RVLS with the RVSWI were found (r = -0.75; r = -0.82; respectively; both P rights reserved.

  14. Providing Policy Implication Based on the R and D Portfolio Analysis in Advanced Countries in the Nuclear Technology

    Energy Technology Data Exchange (ETDEWEB)

    Moon, K. H.; Lee, M. K.; Won, B. C.; Kim, S. S.; Lee, J. H.; Yun, S. W.; Jeong, I. K.; Lee, Y. C.; Lee, Y. J.; Kim, Y. S.

    2013-08-15

    This study is to provide the investment direction of nuclear R and D, which is the most efficient and reasonable integrating the various aspects comprehensively. This study includes four parts. In the first part, we extracted Mega-trend and driving forces of nuclear R and D field by using various reports published by National Intelligence Council of US, UN, etc. Also, in this part we established the linkage between megatrend factors focussing on nuclear and the five aspects including society, technology, ecology, economics and politics. In the second part, we analyzed the nuclear R and D investment directions of major advanced countries including US, Japan, EU and China for comparing the investment portfolio in the specific research area. In the third part, domestic investment of nuclear R and D was reviewed by analyzing the investment trend of nuclear R and D in the past, with their connection to nuclear policy, and to the levels and capacities of national technologies of nuclear. In the final part, the desirable directions of nuclear R and D investment were suggested comprehensively taking into consideration various aspects including the Mega-trend associated with nuclear, nuclear R and D directions of major advanced countries, and the level and capacities of the domestic nuclear technologies.

  15. Providing Policy Implication Based on the R and D Portfolio Analysis in Advanced Countries in the Nuclear Technology

    International Nuclear Information System (INIS)

    Moon, K. H.; Lee, M. K.; Won, B. C.; Kim, S. S.; Lee, J. H.; Yun, S. W.; Jeong, I. K.; Lee, Y. C.; Lee, Y. J.; Kim, Y. S.

    2013-08-01

    This study is to provide the investment direction of nuclear R and D, which is the most efficient and reasonable integrating the various aspects comprehensively. This study includes four parts. In the first part, we extracted Mega-trend and driving forces of nuclear R and D field by using various reports published by National Intelligence Council of US, UN, etc. Also, in this part we established the linkage between megatrend factors focussing on nuclear and the five aspects including society, technology, ecology, economics and politics. In the second part, we analyzed the nuclear R and D investment directions of major advanced countries including US, Japan, EU and China for comparing the investment portfolio in the specific research area. In the third part, domestic investment of nuclear R and D was reviewed by analyzing the investment trend of nuclear R and D in the past, with their connection to nuclear policy, and to the levels and capacities of national technologies of nuclear. In the final part, the desirable directions of nuclear R and D investment were suggested comprehensively taking into consideration various aspects including the Mega-trend associated with nuclear, nuclear R and D directions of major advanced countries, and the level and capacities of the domestic nuclear technologies

  16. Dynamic Failure and Fragmentation of a Hot-Pressed Boron Carbide

    Science.gov (United States)

    Sano, Tomoko; Vargas-Gonzalez, Lionel; LaSalvia, Jerry; Hogan, James David

    2017-12-01

    This study investigates the failure and fragmentation of a hot-pressed boron carbide during high rate impact experiments. Four impact experiments are performed using a composite-backed target configuration at similar velocities, where two of the impact experiments resulted in complete target penetration and two resulted in partial penetration. This paper seeks to evaluate and understand the dynamic behavior of the ceramic that led to either the complete or partial penetration cases, focusing on: (1) surface and internal failure features of fragments using optical, scanning electron, and transmission electron microscopy, and (2) fragment size analysis using state-of-the-art particle-sizing technology that informs about the consequences of failure. Detailed characterization of the mechanical properties and the microstructure is also performed. Results indicate that transgranular fracture was the primary mode of failure in this boron carbide material, and no stress-induced amorphization features were observed. Analysis of the fragment sizes for the partial and completely penetrated experiments revealed a possible correlation between larger fragment sizes and impact performance. The results will add insight into designing improved advanced ceramics for impact protection applications.

  17. Predicting Bank Financial Failures Using Discriminant Analysis And Support Vector Machines Methods A Comparative Analysis In Commercial Banks In Sudan 2006-2014

    Directory of Open Access Journals (Sweden)

    Mohammed A. SirElkhatim

    2017-04-01

    Full Text Available Bank failures threaten the economic system as a whole. Therefore predicting bank financial failures is crucial to prevent andor lessen its negative effects on the economic system. Financial crises affecting both emerging markets and advanced countries over the centuries have severe economic consequences but they can be hard to prevent and predict identifying financial crises causes remains both science and art said Stijn Claessens assistant director of the International Monetary Fund. While it would be better to mitigate risks financial crises will recur often in waves and better crisis management is therefore important. Analyses of recurrent causes suggest that to prevent crises governments should consider reforms in many underlying areas. That includes developing prudent fiscal and monetary policies better regulating the financial sector including reducing the problem of too-big-to-fail banks and developing effective macro-prudential policies. Despite new regulations and better supervision crises are likely to recur in part because they can reflect deeper problems related to income inequality the political economy and common human behavior. As such improvements in crisis management are also needed. This is originally a classification problem to categorize banks as healthy or non-healthy ones. This study aims to apply Discriminant analysis and Support Vector Machines methods to the bank failure prediction problem in a Sudanese case and to present a comprehensive computational comparison of the classification performances of the techniques tested. Eleven financial and non-financial ratios with six feature groups including capital adequacy asset quality Earning and liquidity CAMELS are selected as predictor variables in the study. Credit risk also been evaluated using logistic analysis to study the effect of Islamic finance modes sectors and payment types used by Sudanese banks with regard to their possibilities of failure. Experimental results

  18. NAPAP: A lesson in science, policy

    International Nuclear Information System (INIS)

    Russell, M.

    1993-01-01

    Perplexing environmental questions, such as acid rain and global warming, cry out for policy solutions based upon solid scientific evidence. Scientists and politicians agree on this but have trouble finding an effective way to do it. Milton Russell of the University of Tennessee and Oak Ridge National Laboratory describes a major, but only partially successful, effort that he believes contains valuable lessons for scientists and policy makers in the future. It is the National Acid Precipitation Assessment Program (NAPAP), launched in 1980 to generate the latest scientific evidence to guide national debate on clean-air legislation. The program open-quotes created an unprecedented body of scientific research on an environmental issue of the first order,close quotes Russell says. Yet, he admits, its influence was virtually nil on the legislation that ultimately emerged on the subject. Russell blames this lack of influence on NAPAP's failure to provide adequate assessment of its research findings, its failure to communicate the results on a timely and effective basis, and on open-quotes political forces that sought legislation rather than a full explication of issues.close quotes Out of the experience, Russell finds lessons for the future: open-quotes First, if the scientific finding are to have an impact on policy, assessment must become a priority as important as scientific research. Second, for projects designed to help decision makers, scientific research must be considered a resource, not an end product. Third, timely, lucid communication must be an essential element of the project, not a marginal activity.close quotes NAPAP, Russell concludes, open-quotes proved a long-term scientific success and a short-term policy disappointment.close quotes Then he warns, open-quotes Future science programs ignore the NAPAP experience at their own risk.close quotes

  19. New pharmacological and technological management strategies in heart failure

    Directory of Open Access Journals (Sweden)

    Chaudhry SP

    2017-03-01

    Full Text Available Sunit-Preet Chaudhry,1 Garrick C Stewart2 1Division of Cardiology, St Vincent Indianapolis, Indianapolis, IN, 2Division of Cardiovascular Medicine, Center for Advanced Heart Disease, Brigham and Women’s Hospital, Boston, MA, USA Abstract: Heart failure is a complex clinical syndrome resulting from impairment of ventricular filling or ejection of blood associated with symptoms of dyspnea, fatigue, as well as peripheral and/or pulmonary edema. This syndrome is progressive and characterized by worsening quality of life despite escalating levels of care, affecting 5.7 million Americans with an annual cost of over $30 billion US dollars. Treatment for this syndrome has evolved over three distinct eras: the nonpharmacological era, the pharmacological era, and the device era, with the focus shifting from symptomatic relief to decreasing morbidity and mortality. Over the past 10 years, the field has undergone a renaissance, with the development of new pharmacologic, hemodynamic monitoring, and device therapies proven to improve outcomes in patients with heart failure. This article will review several recent innovations in the management of patients with heart failure. Keywords: heart failure, heart-assist devices, disease management

  20. Development of a GIS-based failure investigation system for highway soil slopes

    Science.gov (United States)

    Ramanathan, Raghav; Aydilek, Ahmet H.; Tanyu, Burak F.

    2015-06-01

    A framework for preparation of an early warning system was developed for Maryland, using a GIS database and a collective overlay of maps that highlight highway slopes susceptible to soil slides or slope failures in advance through spatial and statistical analysis. Data for existing soil slope failures was collected from geotechnical reports and field visits. A total of 48 slope failures were recorded and analyzed. Six factors, including event precipitation, geological formation, land cover, slope history, slope angle, and elevation were considered to affect highway soil slope stability. The observed trends indicate that precipitation and poor surface or subsurface drainage conditions are principal factors causing slope failures. 96% of the failed slopes have an open drainage section. A majority of the failed slopes lie in regions with relatively high event precipitation ( P>200 mm). 90% of the existing failures are surficial erosion type failures, and only 1 out of the 42 slope failures is deep rotational type failure. More than half of the analyzed slope failures have occurred in regions having low density land cover. 46% of failures are on slopes with slope angles between 20° and 30°. Influx of more data relating to failed slopes should give rise to more trends, and thus the developed slope management system will aid the state highway engineers in prudential budget allocation and prioritizing different remediation projects based on the literature reviewed on the principles, concepts, techniques, and methodology for slope instability evaluation (Leshchinsky et al., 2015).

  1. A preventive maintenance policy based on dependent two-stage deterioration and external shocks

    International Nuclear Information System (INIS)

    Yang, Li; Ma, Xiaobing; Peng, Rui; Zhai, Qingqing; Zhao, Yu

    2017-01-01

    This paper proposes a preventive maintenance policy for a single-unit system whose failure has two competing and dependent causes, i.e., internal deterioration and sudden shocks. The internal failure process is divided into two stages, i.e. normal and defective. Shocks arrive according to a non-homogeneous Poisson process (NHPP), leading to the failure of the system immediately. The occurrence rate of a shock is affected by the state of the system. Both an age-based replacement and finite number of periodic inspections are schemed simultaneously to deal with the competing failures. The objective of this study is to determine the optimal preventive replacement interval, inspection interval and number of inspections such that the expected cost per unit time is minimized. A case study on oil pipeline maintenance is presented to illustrate the maintenance policy. - Highlights: • A maintenance model based on two-stage deterioration and sudden shocks is developed. • The impact of internal system state on external shock process is studied. • A new preventive maintenance strategy combining age-based replacements and periodic inspections is proposed. • Postponed replacement of a defective system is provided by restricting the number of inspections.

  2. Belonging together: dealing with the politics of disenchantment in Australian Indigenous policy

    National Research Council Canada - National Science Library

    Sullivan, Patrick

    2011-01-01

    .... It provides a unique overview of the trajectory of current policy, advancing a new consolidated approach to Indigenous policy that moves beyond the debate over self-determination and assimilation...

  3. Investigating the Failure of State Owned Enterprises (SOEs of an Emerging Economy: A Comparative Case Study

    Directory of Open Access Journals (Sweden)

    Rajib Salah Uddin

    2016-08-01

    Full Text Available This study investigates the failure and aftermath of state owned enterprises (SOEs of an emerging economy, Bangladesh. Failure of SOEs of emerging economy has been investigated by many researchers during the last few decades. This study is an extension of previous research. Through the comparative case study, this study tries to explore the scenario of failure of SOEs, the causal factors of failure, remedial actions and aftermath in SOEs. The findings indicate that different authorities from the policy maker to the operating level employees cannot avoid the responsibilities for failure. Even proper restructuring within the ownership of government can drive the firm positively. It is expected that the comparative case study will help to make the decision for the concerned authorities of Bangladesh as well as the authorities of other countries of the world who are in the same position.

  4. Sorafenib-Associated Heart Failure Complicated by Cardiogenic Shock after Treatment of Advanced Stage Hepatocellular Carcinoma: A Clinical Case Discussion

    Directory of Open Access Journals (Sweden)

    Candace Wu

    2017-01-01

    Full Text Available Background. Sorafenib, an oral tyrosine kinase inhibitor (TKI, targets multiple tyrosine kinase receptors (TKRs involved in angiogenesis and tumor growth. Studies suggest that inhibition of TKR impacts cardiomyocyte survival. Inhibition of VEGF signaling interrupts angiogenesis and is associated with the development of hypertension and compensatory hypertrophy. Compensated hypertrophy ultimately leads to heart failure. Case Description. A 76-year-old man with a past medical history of systolic heart failure due to ischemic cardiomyopathy and stage IIIC hepatocellular carcinoma (HCC presented with symptoms of decompensated heart failure. Four months prior to admission, he was started on sorafenib. Results. Our patient was treated with intravenous furosemide and guideline directed therapy. Clinical status was complicated by the development of low cardiac output and shock requiring inotropic support. Careful titration of heart failure medication led to hemodynamic improvement and discontinuation of dobutamine. Conclusion. Greater awareness of sorafenib cardiotoxicity is essential. As TKI usage grows for treatment of cancers, heart failure-related complications will increase. In our patient, routine heart failure management and cessation of sorafenib led to clinical improvement. Future studies on the treatment of sorafenib cardiotoxicity should be explored further in this unique patient population.

  5. Moving an Evidence-Based Policy Agenda Forward: Leadership Tips From the Field.

    Science.gov (United States)

    Garrett, Teresa

    2018-05-01

    Advancing evidence-based policy change is a leadership challenge that nurses should embrace. Key tips to ensure that evidence-based policy changes are successful at the individual, community, and population levels are offered to help nurses through the change process. The public trust in the nursing profession is a leverage point that should be used to advance the use of evidence, expedite change, and improve health for students and across communities.

  6. Development of National Technology Audit Policy

    Directory of Open Access Journals (Sweden)

    Subiyanto Subiyanto

    2017-07-01

    Full Text Available The Laws have mandated implementation of technology audit, nevertheless such implementation needs an additional policy that is more technical. The concept of national audit technology policy shall make technology audit as a tool to ensure the benefit of technology application for society and technology advance for nation independency. This article discusses on technology audit policy concept especially infrastructure requirement, with emphasis on regulation, implementation tools, and related institution. The development of technology audit policy for national interest requires provision of mandatory audit implementation, accompanied by tools for developing technology auditor’s competence and technology audit institutional’s mechanism. To guide technology auditor’s competence, concept of national audit technology policy shall classify object of technology audit into product technology, production technology, and management of technology, accompanied by related parameters of technology performance evaluation.

  7. Investigation and Classification of Short-Circuit Failure Modes Based on Three-Dimensional Safe Operating Area for High-Power IGBT Modules

    DEFF Research Database (Denmark)

    Chen, Yuxiang; Li, Wuhua; Iannuzzo, Francesco

    2018-01-01

    is implemented to motivate advanced contributions in future dependence research of device short-circuit failure modes on temperature. Consequently, a comprehensive and thoughtful review of where the development of short-circuit failure mode research works of IGBT stands and is heading is provided....

  8. Musculoskeletal disorders as a fatigue failure process: evidence, implications and research needs.

    Science.gov (United States)

    Gallagher, Sean; Schall, Mark C

    2017-02-01

    Mounting evidence suggests that musculoskeletal disorders (MSDs) may be the result of a fatigue failure process in musculoskeletal tissues. Evaluations of MSD risk in epidemiological studies and current MSD risk assessment tools, however, have not yet incorporated important principles of fatigue failure analysis in their appraisals of MSD risk. This article examines the evidence suggesting that fatigue failure may play an important role in the aetiology of MSDs, assesses important implications with respect to MSD risk assessment and discusses research needs that may be required to advance the scientific community's ability to more effectively prevent the development of MSDs. Practitioner Summary: Evidence suggests that musculoskeletal disorders (MSDs) may result from a fatigue failure process. This article proposes a unifying framework that aims to explain why exposure to physical risk factors contributes to the development of work-related MSDs. Implications of that framework are discussed.

  9. Primary ICD-therapy in patients with advanced heart failure: selection strategies and future trials.

    Science.gov (United States)

    Frankenstein, Lutz; Zugck, Christian; Nelles, Manfred; Schellberg, Dieter; Remppis, Andrew; Katus, Hugo

    2008-09-01

    For allocation of primary ICD-therapy, a possible lower limit of inclusion criteria--defining overly advanced heart failure--is less well investigated. Also, a multi-variable approach to stratification beyond ejection fraction (LVEF) appears warranted. We examined whether adding a selection limit of peak VO(2)

  10. The role of sequential chemoradiation for local advanced oropharyngeal carcinoma

    International Nuclear Information System (INIS)

    Masterson, Liam; Tanweer, Faiz

    2013-01-01

    This study aims to assess survival, prognostic indicators, and pattern of failure for advanced oropharyngeal cancer treated by induction chemotherapy followed by concomitant chemoradiation (sequential CRT). A retrospective review of 80 consecutive patients who underwent chemoradiation [doublet cisplatin and 5-fluorouracil (PF)] for local advanced oropharyngeal carcinoma at a tertiary center from March 2003 to July 2008 is reported. Seven studies utilizing a similar protocol were reviewed, and all outcomes are collated. At a median follow-up of 32 months, the 3-year overall survival was 75%. Tumor size (p<0.001), age at presentation (p<0.002), and failure to complete the full course of induction chemotherapy (p<0.01) were all found to be significant factors affecting survival. Induction chemotherapy followed by concomitant chemoradiation utilizing doublet PF is an effective treatment for local advanced oropharyngeal carcinoma. At present, the addition of a taxane to the PF regimen cannot be assumed to provide benefit until further evidence emerges from a representative controlled trial. (author)

  11. Stochastic failure modelling of unidirectional composite ply failure

    International Nuclear Information System (INIS)

    Whiteside, M.B.; Pinho, S.T.; Robinson, P.

    2012-01-01

    Stochastic failure envelopes are generated through parallelised Monte Carlo Simulation of a physically based failure criteria for unidirectional carbon fibre/epoxy matrix composite plies. Two examples are presented to demonstrate the consequence on failure prediction of both statistical interaction of failure modes and uncertainty in global misalignment. Global variance-based Sobol sensitivity indices are computed to decompose the observed variance within the stochastic failure envelopes into contributions from physical input parameters. The paper highlights a selection of the potential advantages stochastic methodologies offer over the traditional deterministic approach.

  12. Major amputation for intractable extremity melanoma after failure of isolated limb perfusion

    NARCIS (Netherlands)

    Kapma, M. R.; Vrouenraets, B. C.; Nieweg, O. E.; van Geel, A. N.; Noorda, E. M.; Eggermont, A. M. M.; Kroon, B. B. R.

    2005-01-01

    AIM: The aim of this study was to analyse indications and results of amputation for intractable extremity melanoma after failure of isolated limb perfusion (ILP). METHODS: Between 1978 and 2001, 451 patients with loco-regional advanced extremity melanoma underwent 505 ILPs. Amputation of the

  13. Evolutionary developments of advanced PWR nuclear fuels and cladding materials

    International Nuclear Information System (INIS)

    Kim, Kyu-Tae

    2013-01-01

    Highlights: • PWR fuel and cladding materials development processes are provided. • Evolution of PWR advanced fuel in U.S.A. and in Korea is described. • Cutting-edge design features against grid-to-rod fretting and debris are explained. • High performance data of advanced grids, debris filters and claddings are given. -- Abstract: The evolutionary developments of advanced PWR fuels and cladding materials are explained with outstanding design features of nuclear fuel assembly components and zirconium-base cladding materials. The advanced PWR fuel and cladding materials development processes are also provided along with verification tests, which can be used as guidelines for newcomers planning to develop an advanced fuel for the first time. The up-to-date advanced fuels with the advanced cladding materials may provide a high level of economic utilization and reliable performance even under current and upcoming aggressive operating conditions. To be specific, nuclear fuel vendors may achieve high fuel burnup capability of between 45,000 and 65,000 MWD/MTU batch average, overpower thermal margin of as much as 15% and longer cycle length up to 24 months on the one hand and fuel failure rates of around 10 −6 on the other hand. However, there is still a need for better understanding of grid-to-rod fretting wear mechanisms leading to major PWR fuel defects in the world and subsequently a driving force for developing innovative spacer grid designs with zero fretting wear-induced fuel failure

  14. Ovarian failure due to cancer treatment and fertility preservation options

    Directory of Open Access Journals (Sweden)

    Soheila Aminimoghaddam

    2016-04-01

    Full Text Available Primary ovarian insufficiency (POI, commonly referred to premature ovarian failure, is defined as ovarian failure before the age of 40 years. It is the loss of ovarian function caused by a process directly affecting ovaries. Cancer therapy which includes surgery, radiotherapy, and chemotherapy influence ovarian function, leading to premature menopause and loss of fertility. POI is idiopathic in most cases (74-90%. The known causes, in addition to anticancer treatment, are other processes like chromosomal abnormalities, autoimmunity, and natural aging can result in secondary ovarian failure, which is detected by an increase in serum gonadotropin levels (FSH and LH. There are evident risks of POI in women treated for cancer. Those who receive anticancer treatments have an increased risk of developing POI. There by, anticancer drugs and radiation therapy are considered as the most common toxins of ovaries. Although cancer incidence rates in women less than 50 years old continue to increase during recent years, mortality rates are dramatically decreasing due to modern advances in treatment. Increasing numbers of survivors are now confronted with the long-term consequences of exposure to these treatments. The pool of primordial follicles in the ovary is fixed and any injury to the ovary can potentially reduce this ovarian reserve, effectively advancing the patient’s reproductive age, thus narrowing the window of reproductive opportunity. Ovarian failure occurs in a significant percentage of childhood cancer survivors and many of them will seek care for reproductive dysfunction. Nevertheless, Embryo cryopreservation, oocyte cryopreservation, ovary tissue cryopreservation, ovarian suppression and oophoro-pexy are some options to preserve fertility in these groups. As a result, having foreknowledge of potential treatment related ovarian failure will allow the physician to give a better counsel to patients and their family regarding the importance and

  15. The evolution of international policies and mechanisms to advance sustainable forest management and mitigate global climate change

    International Nuclear Information System (INIS)

    Bologna, J.; Lyke, J.; Theophile, K.

    1995-01-01

    Scientific findings regarding global climate change and deforestation led industrialized nations to bring both issues to the forefront of an international dialogue on the environment. International institutional attention to deforestation began in 1985 with the Tropical Forestry Action Program which helped countries develop plans for sustainable forest management. A few years later, the International Tropical Timber Organization, though designed to facilitate tropical timber trade, adopted guidelines for sustainable management of tropical production forests. Next, the activities before and after UNCED established a general set of forest principles and regional efforts to define sustainable forest management. The World Bank has also sought to reduce past lending failures that led to deforestation and other environmental degradation, through programmatic redirections and macro-economic policy reforms. Finally, through innovative financial incentives, industrialized and developing countries are identifying opportunities to offset debts and increase economic development without depleting forest resources. Collectively, these efforts have let to some trends that support sustainable forest management and mitigate climate change. The upcoming years will see a proactive set of multilateral programs to address deforestation, an increasing link between trade and the environment, and more uses of financial incentives to encourage sustainable forest management

  16. Advances in bioartificial liver assist devices.

    Science.gov (United States)

    Patzer, J F

    2001-11-01

    Rapid advances in development of bioartificial liver assist devices (BLADs) are exciting clinical interest in the application of BLAD technology for support of patients with acute liver failure. Four devices (Circe Biomedical HepatAssist, Vitagen ELAD, Gerlach BELS, and Excorp Medical BLSS) that rely on hepatocytes cultured in hollow-fiber membrane technology are currently in various stages of clinical evaluation. Several alternative approaches for culture and perfusion of hepatocytes have been evaluated in preclinical, large animal models of liver failure, or at a laboratory scale. Engineering design issues with respect to xenotransplantation, BLAD perfusion, hepatocyte functionality and culture maintenance, and ultimate distribution of a BLAD to a clinical site are delineated.

  17. Belonging together: dealing with the politics of disenchantment in Australian Indigenous policy

    National Research Council Canada - National Science Library

    Sullivan, Patrick

    2011-01-01

    .... Advancing the body of knowledge in the field of the anthropology of policy and public administration, this empirical study is a must-read for policy-makers, academics, and indigenous peoples alike.

  18. Distributed sensor coordination for advanced energy systems

    Energy Technology Data Exchange (ETDEWEB)

    Tumer, Kagan [Oregon State Univ., Corvallis, OR (United States). School of Mechanical, Industrial and Manufacturing Engineering

    2015-03-12

    coordination, and sensor network control in advanced power systems. Each application has specific needs, but they all share the one crucial underlying problem: how to ensure that the interactions of a large number of heterogenous agents lead to coordinated system behavior. This proposal describes a new paradigm that addresses that very issue in a systematic way. Key Results and Findings: All milestones have been completed. Our results demonstrate that by properly shaping agent objective functions, we can develop large (up to 10,000 devices) heterogeneous sensor networks with key desirable properties. The first milestone shows that properly choosing agent-specific objective functions increases system performance by up to 99.9% compared to global evaluations. The second milestone shows evolutionary algorithms learn excellent sensor network coordination policies prior to network deployment, and these policies can be refined online once the network is deployed. The third milestone shows the resulting sensor networks networks are extremely robust to sensor noise, where networks with up to 25% sensor noise are capable of providing measurements with errors on the order of 10⁻³. The fourth milestone shows the resulting sensor networks are extremely robust to sensor failure, with 25% of the sensors in the system failing resulting in no significant performance losses after system reconfiguration.

  19. Uncertainties and quantification of common cause failure rates and probabilities for system analyses

    International Nuclear Information System (INIS)

    Vaurio, Jussi K.

    2005-01-01

    Simultaneous failures of multiple components due to common causes at random times are modelled by constant multiple-failure rates. A procedure is described for quantification of common cause failure (CCF) basic event probabilities for system models using plant-specific and multiple-plant failure-event data. Methodology is presented for estimating CCF-rates from event data contaminated with assessment uncertainties. Generalised impact vectors determine the moments for the rates of individual systems or plants. These moments determine the effective numbers of events and observation times to be input to a Bayesian formalism to obtain plant-specific posterior CCF-rates. The rates are used to determine plant-specific common cause event probabilities for the basic events of explicit fault tree models depending on test intervals, test schedules and repair policies. Three methods are presented to determine these probabilities such that the correct time-average system unavailability can be obtained with single fault tree quantification. Recommended numerical values are given and examples illustrate different aspects of the methodology

  20. Cognitive influences on self-care decision making in persons with heart failure.

    Science.gov (United States)

    Dickson, Victoria V; Tkacs, Nancy; Riegel, Barbara

    2007-09-01

    Despite advances in management, heart failure is associated with high rates of hospitalization, poor quality of life, and early death. Education intended to improve patients' abilities to care for themselves is an integral component of disease management programs. True self-care requires that patients make decisions about symptoms, but the cognitive deficits documented in 30% to 50% of the heart failure population may make daily decision making challenging. After describing heart failure self-care as a naturalistic decision making process, we explore cognitive deficits known to exist in persons with heart failure. Problems in heart failure self-care are analyzed in relation to neural alterations associated with heart failure. As a neural process, decision making has been traced to regions of the prefrontal cortex, the same areas that are affected by ischemia, infarction, and hypoxemia in heart failure. Resulting deficits in memory, attention, and executive function may impair the perception and interpretation of early symptoms and reasoning and, thereby, delay early treatment implementation. There is compelling evidence that the neural processes critical to decision making are located in the same structures that are affected by heart failure. Because self-care requires the cognitive ability to learn, perceive, interpret, and respond, research is needed to discern how neural deficits affects these abilities, decision-making, and self-care behaviors.

  1. A competing risk model of first failure site after definitive (chemo) radiation therapy for locally advanced non-small cell lung cancer

    DEFF Research Database (Denmark)

    Nygård, Lotte; Vogelius, Ivan R; Fischer, Barbara M

    2018-01-01

    INTRODUCTION: The aim of the study was to build a model of first failure site and lesion specific failure probability after definitive chemo-radiotherapy for inoperable non-small cell lung cancer (NSCLC). METHODS: We retrospectively analyzed 251 patients receiving definitive chemo......-regional failure, multivariable logistic regression was applied to assess risk of each lesion being first site of failure. The two models were used in combination to predict lesion failure probability accounting for competing events. RESULTS: Adenocarcinoma had a lower hazard ratio (HR) of loco-regional (LR...

  2. 6 Sigma project advance

    International Nuclear Information System (INIS)

    2002-12-01

    This book deals with 6 sigma project advance which introduces 6 sigma project in Changwon special steel, how is failure accepted? CTQ selection which is starting line, definition of performance standard, measurement system check on reliability of measurement data, check of process capacity for current level, establishment of target, optimal design and performance of application, practice of management system for maintain of improved result, CTQ selection, check of measurement system and practice of management system.

  3. Relationship of hemoglobin and hematocrit to systolic function in advanced heart failure.

    Science.gov (United States)

    Guglin, Maya; Darbinyan, Nellie

    2012-01-01

    The dataset from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial provides a rare opportunity to evaluate the whole spectrum of associations of hemoglobin (HB) and hematocrit (HCT) in heart failure (HF). In that trial, subjective and objective data were recorded at multiple time points when HB and HCT were also measured. We investigated the relationship between anemia and ventricular systolic function. A limited access dataset from the ESCAPE trial, provided by the National Heart, Lung and Blood Institute, was analyzed. Linear regression analysis, correlation coefficients and Student's t test were utilized. Besides the known association of anemia with poor prognosis, more severe symptoms, decreased functional capacity and impaired kidney function, we found a significant and very consistent inverse correlation between HB and HCT and ventricular contractility. Both left ventricular ejection fraction and right ventricular fractional area change improved with a decrease in HB and vice versa. We hypothesize that this effect can result from a change in viscosity, which decreases with a decrease in HCT, and may facilitate adaptation of the heart to a volume overload state accompanied by hemodilution. In HF, anemia is associated with poor prognosis and functional impairment, but also with mildly improved systolic function. It may represent an adaptive reaction to congestion. Copyright © 2012 S. Karger AG, Basel.

  4. The second pillar of the CAP: the role of Commission policy learning in the creation and reform of EU rural development policy (1968-1999)

    DEFF Research Database (Denmark)

    Steffensen, Jonny Trapp

    argument advanced in this thesis is that policy learning is a multifaceted phenomenon that can most reliably be examined employing 'method pluralism' (documentary analysis, elite interviews, and survey techniques). A second theoretical assertion is that policy learning can change the beliefs - termed......This thesis examines the concept of 'policy learning' and explores its applicability to the European Commission's role in EU policymaking. Policy learning refers to 'knowledge-based' policy formulation, where content of policy proposals is shaped to a 'non-trivial' extent by administrative...... 'policy strategy' - of political actors. A third theoretical contribution is the concept of 'bureaucratic policy learning capability' (BPLC) which refers to an organisation's ability and inclination to utilise available policy-relevant knowledge. I assess the Commission's BPLC through a survey, designed...

  5. 75 FR 65366 - Recovery Policy RP9524.2, Landslides and Slope Stability Related to Public Facilities

    Science.gov (United States)

    2010-10-22

    ...] Recovery Policy RP9524.2, Landslides and Slope Stability Related to Public Facilities AGENCY: Federal... the final Recovery Policy RP9524.2, Landslides and Slope Stability Related to Public Facilities, which... facilities threatened by landslides or slope failures; as well as the eligibility of permanent repairs to...

  6. The Role of Colleges of Advanced Education in the Education of Adults. A Report to the Australian Commission on Advanced Education.

    Science.gov (United States)

    Nelson, A. J. A.

    This report to the Australian Commission on Advanced Education is intended as a basis for discussion by those who have the responsibility for making program and policy decisions in continuing education in Australia's colleges of advanced education. Though the idea that education is continuous with life is coming to be widely accepted…

  7. Vaccine supply, demand, and policy: a primer.

    Science.gov (United States)

    Muzumdar, Jagannath M; Cline, Richard R

    2009-01-01

    To provide an overview of supply and demand issues in the vaccine industry and the policy options that have been implemented to resolve these issues. Medline, Policy File, and International Pharmaceutical Abstracts were searched to locate academic journal articles. Other sources reviewed included texts on the topics of vaccine history and policy, government agency reports, and reports from independent think tanks. Keywords included vaccines, immunizations, supply, demand, and policy. Search criteria were limited to English language and human studies. Articles pertaining to vaccine demand, supply, and public policy were selected and reviewed for inclusion. By the authors. Vaccines are biologic medications, therefore making their development and production more difficult and costly compared with "small-molecule" drugs. Research and development costs for vaccines can exceed $800 million, and development may require 10 years or more. Strict manufacturing regulations and facility upgrades add to these costs. Policy options to increase and stabilize the supply of vaccines include those aimed at increasing supply, such as government subsidies for basic vaccine research, liability protection for manufacturers, and fast-track approval for new vaccines. Options to increase vaccine demand include advance purchase commitments, government stockpiles, and government financing for select populations. High development costs and multiple barriers to entry have led to a decline in the number of vaccine manufacturers. Although a number of vaccine policies have met with mixed success in increasing the supply of and demand for vaccines, a variety of concerns remain, including developing vaccines for complex pathogens and increasing immunization rates with available vaccines. New policy innovations such as advance market commitments and Medicare Part D vaccine coverage have been implemented and may aid in resolving some of the problems in the vaccine industry.

  8. Emerging methods and tools for environmental risk assessment, decision-making, and policy for nanomaterials: summary of NATO Advanced Research Workshop

    International Nuclear Information System (INIS)

    Linkov, Igor; Steevens, Jeffery; Adlakha-Hutcheon, Gitanjali; Bennett, Erin; Chappell, Mark; Colvin, Vicki; Davis, J. Michael; Davis, Thomas; Elder, Alison; Foss Hansen, Steffen; Hakkinen, Pertti Bert; Hussain, Saber M.; Karkan, Delara; Korenstein, Rafi; Lynch, Iseult; Metcalfe, Chris

    2009-01-01

    Nanomaterials and their associated technologies hold promising opportunities for the development of new materials and applications in a wide variety of disciplines, including medicine, environmental remediation, waste treatment, and energy conservation. However, current information regarding the environmental effects and health risks associated with nanomaterials is limited and sometimes contradictory. This article summarizes the conclusions of a 2008 NATO workshop designed to evaluate the wide-scale implications (e.g., benefits, risks, and costs) of the use of nanomaterials on human health and the environment. A unique feature of this workshop was its interdisciplinary nature and focus on the practical needs of policy decision makers. Workshop presentations and discussion panels were structured along four main themes: technology and benefits, human health risk, environmental risk, and policy implications. Four corresponding working groups (WGs) were formed to develop detailed summaries of the state-of-the-science in their respective areas and to discuss emerging gaps and research needs. The WGs identified gaps between the rapid advances in the types and applications of nanomaterials and the slower pace of human health and environmental risk science, along with strategies to reduce the uncertainties associated with calculating these risks.

  9. Crop Prices in the Austrian Monarchy (1770–1816: The Role of Crop Failures and Money Inflation

    Directory of Open Access Journals (Sweden)

    Blahovec Jiří

    2015-09-01

    Full Text Available The paper is based on data about local cereal prices in Bohemia recorded in the course of 46 years (1770-1816 by F.J. Vavák, Czech farmer living close to Prague. This information appeared in a series of his memoirs published within 1907-1938 and in 2009. The data analysis shows that annual means of prices of wheat, rye, and barley are relatively well correlated and can be used for illustration of the state monetary situation. A higher variation of the annual mean values was observed only in times of crop failure and was also related to the new harvest. The data obtained for pea differ from the data mentioned above. It was shown that the market prices were influenced mainly by crop failures caused by weather and climate and by the state monetary policies. The money purchasing power was influenced either by objective causes, like crop failures of reversible character, or by subjective changes caused mainly by inflationary monetary policies which in the case of Austria had conduced to a state bankruptcy.

  10. Living with fire: Fire ecology and policy for the twenty-first century [book review

    Science.gov (United States)

    Carol Miller

    2010-01-01

    This is a well-written polemic about the failure of fire policy and management in the United States. The book contains enough ecology and history for nonspecialists to understand the complexities of the policy and management dilemmas that we face today. The authors provide a particularly good treatment of the diversity of roles that fire plays in different ecosystems,...

  11. Advancing Health Marketing Research and Policy Recommendations by Incorporating Source Perspectives.

    Science.gov (United States)

    Mackert, Michael; Guadagno, Marie; Champlin, Sara

    2015-01-01

    Communication researchers, recognizing the message sent is not necessarily the same as the message received, have incorporated the perspective of advertising professionals into the study of advertising effects. Health marketing research could similarly benefit from incorporating this largely absent perspective into the academic and policy debate surrounding the impact of advertising on health issues ranging from obesity to alcohol use. This commentary serves as a call to action to stakeholders in this academic and policy debate: focus on the perspective of advertising professionals to enrich health marketing and public health research in which advertising is the delivery vehicle for health messages.

  12. Effective Macroprudential Policy: Cross-Sector Substitution from Price and Quantity Measures

    NARCIS (Netherlands)

    Cizel, J.; Frost, J.; Houben, A.; Wierts, P.

    Macroprudential policy is increasingly being implemented worldwide. Key questions are its effectiveness in influencing bank credit and substitution effects beyond banking. Our results confirm the expected effects of macroprudential policies on bank credit, both for advanced economies and emerging

  13. Predictive factors for renal failure and a control and treatment algorithm

    Directory of Open Access Journals (Sweden)

    Denise de Paula Cerqueira

    2014-04-01

    Full Text Available OBJECTIVES: to evaluate the renal function of patients in an intensive care unit, to identify the predisposing factors for the development of renal failure, and to develop an algorithm to help in the control of the disease.METHOD: exploratory, descriptive, prospective study with a quantitative approach.RESULTS: a total of 30 patients (75.0% were diagnosed with kidney failure and the main factors associated with this disease were: advanced age, systemic arterial hypertension, diabetes mellitus, lung diseases, and antibiotic use. Of these, 23 patients (76.6% showed a reduction in creatinine clearance in the first 24 hours of hospitalization.CONCLUSION: a decline in renal function was observed in a significant number of subjects, therefore, an algorithm was developed with the aim of helping in the control of renal failure in a practical and functional way.

  14. Efficient surrogate models for reliability analysis of systems with multiple failure modes

    International Nuclear Information System (INIS)

    Bichon, Barron J.; McFarland, John M.; Mahadevan, Sankaran

    2011-01-01

    Despite many advances in the field of computational reliability analysis, the efficient estimation of the reliability of a system with multiple failure modes remains a persistent challenge. Various sampling and analytical methods are available, but they typically require accepting a tradeoff between accuracy and computational efficiency. In this work, a surrogate-based approach is presented that simultaneously addresses the issues of accuracy, efficiency, and unimportant failure modes. The method is based on the creation of Gaussian process surrogate models that are required to be locally accurate only in the regions of the component limit states that contribute to system failure. This approach to constructing surrogate models is demonstrated to be both an efficient and accurate method for system-level reliability analysis. - Highlights: → Extends efficient global reliability analysis to systems with multiple failure modes. → Constructs locally accurate Gaussian process models of each response. → Highly efficient and accurate method for assessing system reliability. → Effectiveness is demonstrated on several test problems from the literature.

  15. Dynamic decision-making for reliability and maintenance analysis of manufacturing systems based on failure effects

    Science.gov (United States)

    Zhang, Ding; Zhang, Yingjie

    2017-09-01

    A framework for reliability and maintenance analysis of job shop manufacturing systems is proposed in this paper. An efficient preventive maintenance (PM) policy in terms of failure effects analysis (FEA) is proposed. Subsequently, reliability evaluation and component importance measure based on FEA are performed under the PM policy. A job shop manufacturing system is applied to validate the reliability evaluation and dynamic maintenance policy. Obtained results are compared with existed methods and the effectiveness is validated. Some vague understandings for issues such as network modelling, vulnerabilities identification, the evaluation criteria of repairable systems, as well as PM policy during manufacturing system reliability analysis are elaborated. This framework can help for reliability optimisation and rational maintenance resources allocation of job shop manufacturing systems.

  16. Advanced scheduling for zygote intrafallopian transfer is possible via the use of a hormone replacement cycle for patients who have experienced repeated implantation failures.

    Science.gov (United States)

    Nakagawa, Koji; Juen, Hiroyasu; Nishi, Yayoi; Sugiyama, Rie; Motoyama, Hiroshi; Kuribayashi, Yasushi; Inoue, Masato; Akira, Shigeo; Sugiyama, Rikikazu

    2014-11-01

    Zygote intrafallopian transfer (ZIFT) is an effective option for patients who have experienced repeated implantation failures (RIF) in assisted reproductive technology (ART) treatment. However, advance planning for the day of the operation can be problematic. Using a hormone replacement cycle (HRC) makes it possible to plan for the day of ZIFT. In the present study, we evaluated whether HRC-ZIFT is useful for RIF patients who have experienced difficulties obtaining morphologically good embryos in vitro. A total of 55 patients with a history of five or more unsuccessful transfers received HRC-ZIFT between June 2008 and June 2013. The oocyte pick-ups were performed and the oocytes showing two pronuclei (2PN) were cryopreserved. After receiving more than five 2PN oocytes, the operation day was scheduled in advance, and as a consequence, a HRC was started and ZIFT was performed. The clinical outcomes were evaluated. The average age of the patients was 39.3 years, and the previous OPU and ET attempts numbered 7.5 and 6.9, respectively. The number of previously transferred embryos was 11.8, and the number of morphologically good embryos (MGEs) was only 1.2. The number of transferred 2PN oocytes was 6.7, and the subsequent pregnancy rate was 23.6 %. No ectopic or multiple pregnancies were observed, but there were 6 cases of miscarriage. Among RIF patients, in particular those who have difficulty obtaining MGEs in vitro, ZIFT might be a useful option. The HRC allows patients and medical staff to plan for the operation day in advance.

  17. Metformin and thiazolidinedione use in Medicare patients with heart failure.

    Science.gov (United States)

    Masoudi, Frederick A; Wang, Yongfei; Inzucchi, Silvio E; Setaro, John F; Havranek, Edward P; Foody, JoAnne M; Krumholz, Harlan M

    2003-07-02

    According to package inserts, metformin is contraindicated in diabetic patients receiving drug treatment for heart failure therapy, and thiazolidinediones are not recommended in diabetic patients with symptoms of advanced heart failure. Little is known about patterns of use of these antihyperglycemic drugs in diabetic patients with heart failure. To determine the proportions of patients hospitalized with heart failure and concomitant diabetes treated with metformin or thiazolidinediones. Serial cross-sectional measurements using data from retrospective medical record abstraction. Nongovernmental acute care hospitals in the United States. Two nationally representative samples of Medicare beneficiaries hospitalized with the primary diagnosis of heart failure and concomitant diabetes between April 1998 and March 1999 and between July 2000 and June 2001. The prescription of either metformin or a thiazolidinedione at hospital discharge. In the 1998-1999 sample (n = 12 505), 7.1% of patients were discharged with a prescription for metformin, 7.2% with a prescription for a thiazolidinedione, and 13.5% with a prescription for either drug. In the 2000-2001 sample (n = 13 158), metformin use increased to 11.2%, thiazolidinedione use to 16.1%, and use of either drug to 24.4% (Puse of metformin and thiazolidinediones is common and has increased rapidly in Medicare beneficiaries with diabetes and heart failure in direct contrast with explicit warnings against this practice by the Food and Drug Administration. Further studies to establish the safety and effectiveness of this practice are needed to ensure optimal care of patients with diabetes and heart failure.

  18. Failure mode transition in AHSS resistance spot welds. Part I. Controlling factors

    International Nuclear Information System (INIS)

    Pouranvari, M.; Marashi, S.P.H.

    2011-01-01

    Highlights: → Interfacial to pullout failure mode transition for AHSS RSWs is studied. → An analytical mode is proposed to predict failure mode of AHSS RSWs. → Hardness characteristics of RSWs plays key role in the failure mode transition. - Abstract: Failure mode of resistance spot welds is a qualitative indicator of weld performance. Two major types of spot weld failure are pull-out and interfacial fracture. Interfacial failure, which typically results in reduced energy absorption capability, is considered unsatisfactory and industry standards are often designed to avoid this occurrence. Advanced High Strength Steel (AHSS) spot welds exhibit high tendency to fail in interfacial failure mode. Sizing of spot welds based on the conventional recommendation of 4t 0.5 (t is sheet thickness) does not guarantee the pullout failure mode in many cases of AHSS spot welds. Therefore, a new weld quality criterion should be found for AHSS resistance spot welds to guarantee pull-out failure. The aim of this paper is to investigate and analyze the transition between interfacial and pull-out failure modes in AHSS resistance spot welds during the tensile-shear test by the use of analytical approach. In this work, in the light of failure mechanism, a simple analytical model is presented for estimating the critical fusion zone size to prevent interfacial fracture. According to this model, the hardness ratio of fusion zone to pull-out failure location and the volume fraction of voids in fusion zone are the key metallurgical factors governing type of failure mode of AHSS spot welds during the tensile-shear test. Low hardness ratio and high susceptibility to form shrinkage voids in the case of AHSS spot welds appear to be the two primary causes for their high tendency to fail in interfacial mode.

  19. Advanced Nursing Education: Critical Factors That Influence Diploma and Associate Degree Nurses to Advance.

    Science.gov (United States)

    McGhie-Anderson, Rose Lavine

    The purpose of this study was to gain an understanding of the social processes associated with the decision of diploma and associate degree nurses to advance academically. Advanced nursing education needs to be pursued along the continuum of the nursing career path. This education process is indispensable to the role of nurses as educator, manager, nurse leader, and researcher who will effect policy changes, assume leadership roles as revolutionary thinkers, and implement paradigmatic shifts. Data were collected from two groups of participants using face-to-face, semistructured interviews. Group 1 consisted of diploma and associate degree nurses; Group 2 consisted of baccalaureate, masters, and doctoral degree nurses who have progressed academically. Emerging from the thick, rich data were core categories of rewarding, motivating, and supporting as critical factors that influence professional advancement. This qualitative study elucidated that professional advancement was the social process that grounds. The emergent theory was the theory of professional advancement.

  20. Longterm survival and reason for failure of anterior composite restoration

    Directory of Open Access Journals (Sweden)

    Nina Djustiana

    2016-06-01

    Full Text Available Composites resin restorations have been used for repairing and restoring anterior teeth for decades due to the growing needs for a cost- effective aesthetic restoration and the advancement in dental material and polymer technology. Failure of composite restorations cannot be neglected, due to multiple factors, i.e. failure to diagnose the gingival tissue, inadequate tissue management, quality of remaining tooth structure, and inadequate preparation. The aim of this review is to improve clinical performances of direct composite as permanent restorations. Long lasting aesthetic composite restorations required proper mouth preparations ,which  includes supporting and dental hard tissue preparations, tooth preparation, proper isolation, bonding procedures, light cure unit, and the resin composite itself.